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Himmerich H, Keeler JL, Tchanturia K, Treasure J. Treatment escalation for people with anorexia nervosa: setting, therapies and nutritional interventions. Curr Opin Psychiatry 2024:00001504-990000000-00141. [PMID: 39239867 DOI: 10.1097/yco.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
PURPOSE OF REVIEW Adult patients with severe anorexia nervosa often receive the same unsuccessful treatment without changes regarding the setting, the therapies, or nutritional interventions. RECENT FINDINGS Settings where people with anorexia nervosa are treated include their general practitioner, an independent psychiatric practice, a community mental health team (CMHT), a specialized eating disorder outpatient service, eating disorder early intervention services, a highly intensive eating disorder outpatient or home treatment programme, eating disorder daycare, an inpatient eating disorder service, a general hospital or a general psychiatric hospital, or residential treatment. At a specialized eating disorder service, patients should be offered evidence-based psychotherapy for anorexia nervosa, dietary advice and physical health monitoring as a first step. Additionally, they may be allocated to a specific treatment pathway, family interventions and creative therapies. As a second step, clinicians may consider integrating interventions targeting psychiatric or physical comorbidities, medication for anorexia nervosa or noninvasive neurostimulation. After several years of futile treatment, deep brain stimulation (DBS) should be considered to prevent a chronic course of anorexia nervosa. Nutritional interventions can be escalated from nutritional counselling to nasogastric tube feeding. Patients who rely on nasogastric tube feeding might benefit from percutaneous endoscopic gastrostomy (PEG). Patients with an who vomit despite a nasogastric tube, might need nasojejunal tube feeding. SUMMARY Treatment for people with anorexia nervosa should be regularly reviewed and, if necessary, escalated to avoid a chronic and longstanding disease course.
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Affiliation(s)
- Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Johanna Louise Keeler
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London
| | - Kate Tchanturia
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London
- South London and Maudsley NHS Foundation Trust, London, UK
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Li T, Ma X, Pan W, Huo X. The impact of transcranial direct current stimulation combined with interim testing on spatial route learning in patients with schizophrenia. J Psychiatr Res 2024; 177:169-176. [PMID: 39024741 DOI: 10.1016/j.jpsychires.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 07/06/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Cognitive deficits in patients with schizophrenia have drawn widespread attention. Transcranial direct current stimulation (tDCS) can modulate cognitive processes by altering neuronal excitability. Previous studies have found that interim testing can enhance spatial route learning and memory in patients with schizophrenia. However, there has been limited research on the combined effects of these two methods on spatial route learning in these patients. OBJECTIVE To investigate whether the combination of tDCS and interim testing can effectively contribute to the maintenance of spatial route memory in patients with schizophrenia. The study involved conducting route learning using interim testing after anodal tDCS treatment on the left dorsolateral prefrontal cortex (L-DLPFC). METHODS Ninety-two patients with schizophrenia were recruited and divided into groups receiving anodal, sham, or no stimulation. The anodal group received L-DLPFC tDCS treatment 10 times over 5 days (twice daily for 20 min). After treatment, spatial route learning was assessed in interim testing. Correct recall rates of landmark positions and proactive interference from prior learning were compared among the groups. RESULTS Regardless of stimulation type, the interim testing group outperformed the relearning group. Additionally, recall scores were higher following anodal stimulation, indicating the efficacy of tDCS. CONCLUSIONS Both tDCS and interim testing independently enhance the ability to learn new information in spatial route learning for patients with schizophrenia, indicating that tDCS of the left DLPFC significantly improves memory in these patients.
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Affiliation(s)
- Tiantian Li
- School of Psychology, Northwest Normal University, Lanzhou, 730070, China; Provincial Key Laboratory of Behavioral and Mental Health, Lanzhou, 730070, China
| | - Xiaofeng Ma
- School of Psychology, Northwest Normal University, Lanzhou, 730070, China; Provincial Key Laboratory of Behavioral and Mental Health, Lanzhou, 730070, China.
| | - Wen Pan
- School of Psychology, Northwest Normal University, Lanzhou, 730070, China; Provincial Key Laboratory of Behavioral and Mental Health, Lanzhou, 730070, China
| | - Xiaoning Huo
- The Third People's Hospital of Lanzhou, Lanzhou, China
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Spiroiu FI, Minuzzi L, Duarte D, McCabe RE, Soreni N. Neurocognitive effects of transcranial direct current stimulation in obsessive-compulsive disorder: a systematic review. Int J Neurosci 2024:1-14. [PMID: 38913323 DOI: 10.1080/00207454.2024.2371303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 06/15/2024] [Indexed: 06/25/2024]
Abstract
Transcranial direct current stimulation (tDCS) has been used with increasing frequency as a therapeutic tool to alleviate clinical symptoms of obsessive compulsive-disorder (OCD). However, little is known about the effects of tDCS on neurocognitive functioning among OCD patients. The aim of this review was to provide a comprehensive overview of the literature examining the effects of tDCS on specific neurocognitive functions in OCD. A literature search following PRISMA guidelines was conducted on the following databases: PubMed, PsycINFO, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. The search yielded 4 results: one randomized, sham-controlled study (20 patients), one randomized, controlled, partial crossover trial (12 patients), one open-label study (5 patients), and one randomized, double-blind, sham-controlled, parallel-group trial (37 patients). A total of 51 patients received active tDCS with some diversity in electrode montages targeting the dorsolateral prefrontal cortex, the pre-supplementary motor area, or the orbitofrontal cortex. tDCS was associated with improved decision-making in study 1, enhanced attentional monitoring and response inhibition in study 2, improved executive and inhibitory control in study 3, and reduced attentional bias and improved response inhibition and working memory in study 4. Limitations of this review include its small sample, the absence of a sham group in half of the studies, and the heterogeneity in tDCS parameters. These preliminary results highlight the need for future testing in randomized, sham-controlled trials to examine whether and how tDCS induces relevant cognitive benefits in OCD.
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Affiliation(s)
- Flavia I Spiroiu
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Luciano Minuzzi
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Dante Duarte
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Noam Soreni
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Pediatric OCD Consultation Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Couto TA, Gao F, Lak DC, Yuan Z. Combined EEG-tDCS approach in resting state to reduce comorbid anxiety and depressive symptoms in affective disorders: A sham-controlled pilot study. IBRO Neurosci Rep 2024; 16:571-581. [PMID: 38764542 PMCID: PMC11101867 DOI: 10.1016/j.ibneur.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/19/2024] [Accepted: 04/27/2024] [Indexed: 05/21/2024] Open
Abstract
Continuous challenges have been imposed on mental health science by Anxiety and Depression disorders as the most prevalent and debilitating psychiatric conditions worldwide. Pharmacologic and cognitive behavioral therapies, either alone or in combination, have been considered as the first-line therapies, however, resistant symptomatology is prevalent in comorbid conditions with symptoms remaining after interventions. The demand for new therapeutic solutions has given space to the development of non-invasive brain stimulation techniques (NIBS), and the transmagnetic direct current stimulation (tDCS) has been reported as a safe and well-tolerated technique for the treatment of several mental health conditions, including Anxiety and Depression disorders. Relying on quantitative electroencephalography(qEEG)- tDCS approach, the current study aims to inspect the effect of tDCS intervention on patients who suffer from anxiety-depression comorbidity, in particular, the impact of tDCS intervention on qEEG spectral power activity and resting-state connectivity organization during eyes closed and eyes open protocols. QEEG data were acquired from eight patients suffering from moderate to severe anxiety-depression comorbid symptoms along with poor coping skills to manage stress and negative affect. Twelve control subjects allocated in the control group exhibiting low to moderate symptoms in both anxiety and depression conditions went also through the qEEG data acquisition. In addition, a sham-controlled study was conducted, and the patient group went through resting-state qEEG-tDCS neuromodulation once a week for ten weeks. Various-stage qEEG recordings were performed to inspect the efficacy of tDCS treatment during the modulation of brain regions involved in the regulation of affective responses. Our results demonstrated that after tDCS neuromodulation, the patients' groups exhibited decreased absolute power abnormalities over the left anterior cingulate cortex and reduced abnormal activity in the alpha band over posterior regions; improved functional connectivity indexes; decreased anxiety and depressive scores while positive affect score was improved. Besides the promising improvements, our study did not find a significant tDCS effect on perceived stress and negative affect scores. Consistently, significant differences in absolute spectral power over the left anterior cingulate cortex were detected among the patient group, as compared to the controls, as expected. Therefore, our study offers preliminary data to understand the neuroplasticity changes that potentially result from the manipulation of cortical excitability during affective regulation protocols followed by the consequent decrease of comorbid anxiety and depressive symptomatology. The pilot study was followed by prospective registration with ChiCTR2200062142.
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Affiliation(s)
- Tania A. Couto
- Faculty of Health Sciences. Centre for Cognitive and Brain Sciences. University of Macau, Taipa 999078, Macau, Special Administrative region of China
- Brain, Language and Computation Laboratory. University Research Facility in Behavioural and Systems Neuroscience. The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China
| | - Fei Gao
- Faculty of Health Sciences. Centre for Cognitive and Brain Sciences. University of Macau, Taipa 999078, Macau, Special Administrative region of China
- Fudan University, Shanghai, China
| | - Davis C. Lak
- Alpha Positive Limited, Central, 999077, Hong Kong Special Administrative Region of China
- Department of Psychology. The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Zhen Yuan
- Faculty of Health Sciences. Centre for Cognitive and Brain Sciences. University of Macau, Taipa 999078, Macau, Special Administrative region of China
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Olgiati E, Violante IR, Xu S, Sinclair TG, Li LM, Crow JN, Kapsetaki ME, Calvo R, Li K, Nayar M, Grossman N, Patel MC, Wise RJS, Malhotra PA. Targeted non-invasive brain stimulation boosts attention and modulates contralesional brain networks following right hemisphere stroke. Neuroimage Clin 2024; 42:103599. [PMID: 38608376 PMCID: PMC11019269 DOI: 10.1016/j.nicl.2024.103599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024]
Abstract
Right hemisphere stroke patients frequently present with a combination of lateralised and non-lateralised attentional deficits characteristic of the neglect syndrome. Attentional deficits are associated with poor functional outcome and are challenging to treat, with non-lateralised deficits often persisting into the chronic stage and representing a common complaint among patients and families. In this study, we investigated the effects of non-invasive brain stimulation on non-lateralised attentional deficits in right-hemispheric stroke. In a randomised double-blind sham-controlled crossover study, twenty-two patients received real and sham transcranial Direct Current Stimulation (tDCS) whilst performing a non-lateralised attentional task. A high definition tDCS montage guided by stimulation modelling was employed to maximise current delivery over the right dorsolateral prefrontal cortex, a key node in the vigilance network. In a parallel study, we examined brain network response to this tDCS montage by carrying out concurrent fMRI during stimulation in healthy participants and patients. At the group level, stimulation improved target detection in patients, reducing overall error rate when compared with sham stimulation. TDCS boosted performance throughout the duration of the task, with its effects briefly outlasting stimulation cessation. Exploratory lesion analysis indicated that response to stimulation was related to lesion location rather than volume. In particular, reduced stimulation response was associated with damage to the thalamus and postcentral gyrus. Concurrent stimulation-fMRI revealed that tDCS did not affect local connectivity but influenced functional connectivity within large-scale networks in the contralesional hemisphere. This combined behavioural and functional imaging approach shows that brain stimulation targeted to surviving tissue in the ipsilesional hemisphere improves non-lateralised attentional deficits following stroke. This effect may be exerted via contralesional network effects.
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Affiliation(s)
- Elena Olgiati
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK.
| | - Ines R Violante
- Imperial College London, Department of Brain Sciences, UK; University of Surrey, Department of Psychology, UK
| | - Shuler Xu
- Imperial College London, Department of Brain Sciences, UK; University College London, UK
| | | | - Lucia M Li
- Imperial College London, Department of Brain Sciences, UK; UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK
| | - Jennifer N Crow
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK
| | | | - Roberta Calvo
- UTHealth, Department of Neurobiology and Anatomy, McGovern Medical School, Houston, US
| | - Korina Li
- Imperial College London, Department of Brain Sciences, UK; University College London, UK
| | | | - Nir Grossman
- Imperial College London, Department of Brain Sciences, UK; UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK
| | - Maneesh C Patel
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK
| | - Richard J S Wise
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK
| | - Paresh A Malhotra
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK; UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK
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Leehr EJ, Seeger FR, Böhnlein J, Gathmann B, Straube T, Roesmann K, Junghöfer M, Schwarzmeier H, Siminski N, Herrmann MJ, Langhammer T, Goltermann J, Grotegerd D, Meinert S, Winter NR, Dannlowski U, Lueken U. Association between resting-state connectivity patterns in the defensive system network and treatment response in spider phobia-a replication approach. Transl Psychiatry 2024; 14:137. [PMID: 38453896 PMCID: PMC10920691 DOI: 10.1038/s41398-024-02799-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 03/09/2024] Open
Abstract
Although highly effective on average, exposure-based treatments do not work equally well for all patients with anxiety disorders. The identification of pre-treatment response-predicting patient characteristics may enable patient stratification. Preliminary research highlights the relevance of inhibitory fronto-limbic networks as such. We aimed to identify pre-treatment neural signatures differing between exposure treatment responders and non-responders in spider phobia and to validate results through rigorous replication. Data of a bi-centric intervention study comprised clinical phenotyping and pre-treatment resting-state functional connectivity (rsFC) data of n = 79 patients with spider phobia (discovery sample) and n = 69 patients (replication sample). RsFC data analyses were accomplished using the Matlab-based CONN-toolbox with harmonized analyses protocols at both sites. Treatment response was defined by a reduction of >30% symptom severity from pre- to post-treatment (Spider Phobia Questionnaire Score, primary outcome). Secondary outcome was defined by a reduction of >50% in a Behavioral Avoidance Test (BAT). Mean within-session fear reduction functioned as a process measure for exposure. Compared to non-responders and pre-treatment, results in the discovery sample seemed to indicate that responders exhibited stronger negative connectivity between frontal and limbic structures and were characterized by heightened connectivity between the amygdala and ventral visual pathway regions. Patients exhibiting high within-session fear reduction showed stronger excitatory connectivity within the prefrontal cortex than patients with low within-session fear reduction. Whereas these results could be replicated by another team using the same data (cross-team replication), cross-site replication of the discovery sample findings in the independent replication sample was unsuccessful. Results seem to support negative fronto-limbic connectivity as promising ingredient to enhance response rates in specific phobia but lack sufficient replication. Further research is needed to obtain a valid basis for clinical decision-making and the development of individually tailored treatment options. Notably, future studies should regularly include replication approaches in their protocols.
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Affiliation(s)
- Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Münster, Germany.
| | - Fabian R Seeger
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Joscha Böhnlein
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Bettina Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
- Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany
| | - Kati Roesmann
- Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany
- Institute for Clinical Psychology and Psychotherapy, University of Siegen, Siegen, Germany
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
- Institute of Psychology, Unit of Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Osnabrück, Osnabrück, Germany
| | - Markus Junghöfer
- Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Hanna Schwarzmeier
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Niklas Siminski
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Till Langhammer
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Nils R Winter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), partner site Berlin/Potsdam, Berlin, Germany
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Aberra AS, Wang R, Grill WM, Peterchev AV. Multi-scale model of axonal and dendritic polarization by transcranial direct current stimulation in realistic head geometry. Brain Stimul 2023; 16:1776-1791. [PMID: 38056825 PMCID: PMC10842743 DOI: 10.1016/j.brs.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation modality that can alter cortical excitability. However, it remains unclear how the subcellular elements of different neuron types are polarized by specific electric field (E-field) distributions. OBJECTIVE To quantify neuronal polarization generated by tDCS in a multi-scale computational model. METHODS We embedded layer-specific, morphologically-realistic cortical neuron models in a finite element model of the E-field in a human head and simulated steady-state polarization generated by conventional primary-motor-cortex-supraorbital (M1-SO) and 4 × 1 high-definition (HD) tDCS. We quantified somatic, axonal, and dendritic polarization of excitatory pyramidal cells in layers 2/3, 5, and 6, as well as inhibitory interneurons in layers 1 and 4 of the hand knob. RESULTS Axonal and dendritic terminals were polarized more than the soma in all neurons, with peak axonal and dendritic polarization of 0.92 mV and 0.21 mV, respectively, compared to peak somatic polarization of 0.07 mV for 1.8 mA M1-SO stimulation. Both montages generated regions of depolarization and hyperpolarization beneath the M1 anode; M1-SO produced slightly stronger, more diffuse polarization peaking in the central sulcus, while 4 × 1 HD produced higher peak polarization in the gyral crown. The E-field component normal to the cortical surface correlated strongly with pyramidal neuron somatic polarization (R2>0.9), but exhibited weaker correlations with peak pyramidal axonal and dendritic polarization (R2:0.5-0.9) and peak polarization in all subcellular regions of interneurons (R2:0.3-0.6). Simulating polarization by uniform local E-field extracted at the soma approximated the spatial distribution of tDCS polarization but produced large errors in some regions (median absolute percent error: 7.9 %). CONCLUSIONS Polarization of pre- and postsynaptic compartments of excitatory and inhibitory cortical neurons may play a significant role in tDCS neuromodulation. These effects cannot be predicted from the E-field distribution alone but rather require calculation of the neuronal response.
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Affiliation(s)
- Aman S Aberra
- Dept. of Biomedical Engineering, Pratt School of Engineering, Duke University, NC, USA.
| | - Ruochen Wang
- Dept. of Biomedical Engineering, Pratt School of Engineering, Duke University, NC, USA; Dept. of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, NC, USA.
| | - Warren M Grill
- Dept. of Biomedical Engineering, Pratt School of Engineering, Duke University, NC, USA; Dept. of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, NC, USA; Dept. of Neurobiology, School of Medicine, Duke University, NC, USA; Dept. of Neurosurgery, School of Medicine, Duke University, NC, USA.
| | - Angel V Peterchev
- Dept. of Biomedical Engineering, Pratt School of Engineering, Duke University, NC, USA; Dept. of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, NC, USA; Dept. of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, NC, USA; Dept. of Neurosurgery, School of Medicine, Duke University, NC, USA.
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Esmaeilzadeh Kiabani N, Kazemi R, Hadipour AL, Khomami S, Kalloch B, Hlawitschka M. Targeting the insula with transcranial direct current stimulation; A simulation study. Psychiatry Res Neuroimaging 2023; 335:111718. [PMID: 37738706 DOI: 10.1016/j.pscychresns.2023.111718] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/26/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
Insula is considered an important region of the brain in the generation and maintenance of a wide range of psychiatric symptoms, possibly due to being key in fundamental functions such as interoception and cognition in general. Investigating the possibility of targeting this area using non-invasive brain stimulation techniques can open new possibilities to probe the normal and abnormal functioning of the brain and potentially new treatment protocols to alleviate symptoms of different psychiatric disorders. In the current study, COMETS2, a MATLAB based toolbox was used to simulate the magnitude of the current density and electric field in the brain caused by different transcranial direct current stimulation (tDCS) protocols to find an optimum montage to target the insula and its 6 subregions for three different current intensities, namely 2, 3, and 4 mA. Frontal and occipital regions were found to be optimal candidate regions.. The results of the current study showed that it is viable to reach the insula and its individual subregions using tDCS.
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Affiliation(s)
| | - Reza Kazemi
- Faculty of Entrepreneurship, University of Tehran, Tehran, Iran.
| | - Abed L Hadipour
- Department of Cognitive Sciences, University of Messina, Messina, Italy
| | - Sanaz Khomami
- Department of Psychology, South Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Benjamin Kalloch
- Max Planck Institute for Human Cognitive and Brain Sciences, Instiute of Biomedical Engineering and Informatics, Germany & Technische Universität Ilmenau, Ilmenau, Leipzig, Germany
| | - Mario Hlawitschka
- Faculty of Computer Science and Media, Leipzig University of Applied Science, Leipzig, Germany
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9
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Chen L, Chen G, Gong X, Fang F. Integrating electric field modeling and pre-tDCS behavioral performance to predict the individual tDCS effect on visual crowding. J Neural Eng 2023; 20:056019. [PMID: 37750681 DOI: 10.1088/1741-2552/acfa8c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023]
Abstract
Objective.Transcranial direct current stimulation (tDCS) has been broadly used to modulate brain activity with both bipolar and high-definition montages. However, tDCS effects can be highly variable. In this work, we investigated whether the variability in the tDCS effects could be predicted by integrating individualized electric field modeling and individual pre-tDCS behavioral performance.Approach.Here, we first compared the effects of bipolar tDCS and 4 × 1 high-definition tDCS (HD-tDCS) with respect to the alleviation of visual crowding, which is the inability to identify targets in the presence of nearby flankers and considered to be an essential bottleneck of object recognition and visual awareness. We instructed subjects to perform an orientation discrimination task with both isolated and crowded targets in the periphery and measured their orientation discrimination thresholds before and after receiving 20 min of bipolar tDCS, 4 × 1 HD-tDCS, or sham stimulation over the visual cortex. Individual anatomically realistic head models were constructed to simulate tDCS-induced electric field distributions and quantify tDCS focality. Finally, a multiple linear regression model that used pre-tDCS behavioral performance and tDCS focality as factors was used to predict post-tDCS behavioral performance.Main results.We found that HD-tDCS, but not bipolar tDCS, could significantly alleviate visual crowding. Moreover, the variability in the tDCS effect could be reliably predicted by subjects' pre-tDCS behavioral performance and tDCS focality. This prediction model also performed well when generalized to other two tDCS protocols with a different electrode size or a different stimulation intensity.Significance.Our study links the variability in the tDCS-induced electric field and the pre-tDCS behavioral performance in a visual crowding task to the variability in post-tDCS performance. It provides a new approach to predicting individual tDCS effects and highlights the importance of understanding the factors that determine tDCS effectiveness while developing more robust protocols.
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Affiliation(s)
- Luyao Chen
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing 100871, People's Republic of China
- Beijing Academy of Artificial Intelligence, Beijing 100084, People's Republic of China
- IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, People's Republic of China
- Key Laboratory of Machine Perception (Ministry of Education), Peking University, Beijing 100871, People's Republic of China
| | - Guanpeng Chen
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing 100871, People's Republic of China
- IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, People's Republic of China
- Key Laboratory of Machine Perception (Ministry of Education), Peking University, Beijing 100871, People's Republic of China
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100871, People's Republic of China
| | - Xizi Gong
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing 100871, People's Republic of China
- IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, People's Republic of China
- Key Laboratory of Machine Perception (Ministry of Education), Peking University, Beijing 100871, People's Republic of China
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100871, People's Republic of China
| | - Fang Fang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing 100871, People's Republic of China
- Beijing Academy of Artificial Intelligence, Beijing 100084, People's Republic of China
- IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, People's Republic of China
- Key Laboratory of Machine Perception (Ministry of Education), Peking University, Beijing 100871, People's Republic of China
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100871, People's Republic of China
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10
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Aberra AS, Wang R, Grill WM, Peterchev AV. Multi-scale model of axonal and dendritic polarization by transcranial direct current stimulation in realistic head geometry. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.23.554447. [PMID: 37767087 PMCID: PMC10522328 DOI: 10.1101/2023.08.23.554447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Background Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation modality that can alter cortical excitability. However, it remains unclear how the subcellular elements of different neuron types are polarized by specific electric field (E-field) distributions. Objective To quantify neuronal polarization generated by tDCS in a multi-scale computational model. Methods We embedded layer-specific, morphologically-realistic cortical neuron models in a finite element model of the E-field in a human head and simulated steady-state polarization generated by conventional primary-motor-cortex-supraorbital (M1-SO) and 4×1 high-definition (HD) tDCS. We quantified somatic, axonal, and dendritic polarization of excitatory pyramidal cells in layers 2/3, 5, and 6, as well as inhibitory interneurons in layers 1 and 4 of the hand knob. Results Axonal and dendritic terminals were polarized more than the soma in all neurons, with peak axonal and dendritic polarization of 0.92 mV and 0.21 mV, respectively, compared to peak somatic polarization of 0.07 mV for 1.8 mA M1-SO stimulation. Both montages generated regions of depolarization and hyperpolarization beneath the M1 anode; M1-SO produced slightly stronger, more diffuse polarization peaking in the central sulcus, while 4×1 HD produced higher peak polarization in the gyral crown. Simulating polarization by uniform local E-field approximated the spatial distribution of tDCS polarization but produced large errors in some regions. Conclusions Polarization of pre- and postsynaptic compartments of excitatory and inhibitory cortical neurons may play a significant role in tDCS neuromodulation. These effects cannot be predicted from the E-field distribution alone but rather require calculation of the neuronal response.
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11
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Soleimani G, Nitsche MA, Bergmann TO, Towhidkhah F, Violante IR, Lorenz R, Kuplicki R, Tsuchiyagaito A, Mulyana B, Mayeli A, Ghobadi-Azbari P, Mosayebi-Samani M, Zilverstand A, Paulus MP, Bikson M, Ekhtiari H. Closing the loop between brain and electrical stimulation: towards precision neuromodulation treatments. Transl Psychiatry 2023; 13:279. [PMID: 37582922 PMCID: PMC10427701 DOI: 10.1038/s41398-023-02565-5] [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: 07/08/2022] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 08/17/2023] Open
Abstract
One of the most critical challenges in using noninvasive brain stimulation (NIBS) techniques for the treatment of psychiatric and neurologic disorders is inter- and intra-individual variability in response to NIBS. Response variations in previous findings suggest that the one-size-fits-all approach does not seem the most appropriate option for enhancing stimulation outcomes. While there is a growing body of evidence for the feasibility and effectiveness of individualized NIBS approaches, the optimal way to achieve this is yet to be determined. Transcranial electrical stimulation (tES) is one of the NIBS techniques showing promising results in modulating treatment outcomes in several psychiatric and neurologic disorders, but it faces the same challenge for individual optimization. With new computational and methodological advances, tES can be integrated with real-time functional magnetic resonance imaging (rtfMRI) to establish closed-loop tES-fMRI for individually optimized neuromodulation. Closed-loop tES-fMRI systems aim to optimize stimulation parameters based on minimizing differences between the model of the current brain state and the desired value to maximize the expected clinical outcome. The methodological space to optimize closed-loop tES fMRI for clinical applications includes (1) stimulation vs. data acquisition timing, (2) fMRI context (task-based or resting-state), (3) inherent brain oscillations, (4) dose-response function, (5) brain target trait and state and (6) optimization algorithm. Closed-loop tES-fMRI technology has several advantages over non-individualized or open-loop systems to reshape the future of neuromodulation with objective optimization in a clinically relevant context such as drug cue reactivity for substance use disorder considering both inter and intra-individual variations. Using multi-level brain and behavior measures as input and desired outcomes to individualize stimulation parameters provides a framework for designing personalized tES protocols in precision psychiatry.
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Affiliation(s)
- Ghazaleh Soleimani
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Michael A Nitsche
- Department of Psychology and Neuroscience, Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany
- Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy, and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Bielefeld, Germany
| | - Til Ole Bergmann
- Neuroimaging Center, Focus Program Translational Neuroscience, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
- Leibniz Institute for Resilience Research, Mainz, Germany
| | - Farzad Towhidkhah
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Ines R Violante
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guilford, UK
| | - Romy Lorenz
- Department of Psychology, Stanford University, Stanford, CA, USA
- MRC CBU, University of Cambridge, Cambridge, UK
- Department of Neurophysics, MPI, Leipzig, Germany
| | | | | | - Beni Mulyana
- Laureate Institute for Brain Research, Tulsa, OK, USA
- School of Electrical and Computer Engineering, University of Oklahoma, Tulsa, OK, USA
| | - Ahmad Mayeli
- University of Pittsburgh Medical Center, Pittsburg, PA, USA
| | - Peyman Ghobadi-Azbari
- Department of Biomedical Engineering, Shahed University, Tehran, Iran
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Mosayebi-Samani
- Department of Psychology and Neuroscience, Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany
| | - Anna Zilverstand
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Hamed Ekhtiari
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
- Laureate Institute for Brain Research, Tulsa, OK, USA.
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12
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Opposing and emotion-specific associations between frontal activation with depression and anxiety symptoms during facial emotion processing in generalized anxiety and depression. Prog Neuropsychopharmacol Biol Psychiatry 2023; 123:110716. [PMID: 36623581 DOI: 10.1016/j.pnpbp.2023.110716] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/06/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
Major depression (MDD) and generalized anxiety disorder (GAD) have become one of the leading global causes of disability and both are characterized by marked interpersonal and social impairments. However, despite high comorbidity and overlapping social-emotional deficits, it remains unclear whether MDD and GAD share a common neural basis during interpersonal processing. In the present study, we combined an emotional face processing paradigm with fMRI and dimensional and categorical analyses in a sample of unmedicated MDD and GAD patients (N = 72) as well as healthy controls (N = 35). No group differences were found in categorical analyses. However, the dimensional analyses revealed that dorsolateral prefrontal cortex (dlPFC) reactivity to sad facial expressions was positively associated with depression symptom load, yet negatively associated with anxiety symptom load in the entire sample. On the network level depression symptom load was positively associated with functional connectivity between the bilateral amygdala and a widespread network including the anterior cingulate and insular cortex. Together, these findings suggest that the dlPFC - engaged in cognitive and emotional processing - exhibits symptom- and emotion-specific alteration during interpersonal processing. Dysregulated communication between the amygdala and core regions of the salience network may represent depression-specific neural dysregulations.
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Transcranial Direct Current Stimulation (tDCS) in Pediatric Populations—– Voices from Typically Developing Children and Adolescents and their Parents. NEUROETHICS-NETH 2023. [DOI: 10.1007/s12152-022-09507-w] [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
Background
Transcranial direct current stimulation (tDCS) is a brain stimulation technique currently being researched as an alternative or complimentary treatment for various neurological disorders. There is little knowledge about experiences of the participants of tDCS clinical research, especially from pediatric studies.
Methods
An interview study with typically developing minors (n = 19, mean age 13,66 years) participating in a tDCS study, and their parents (n = 18) was conducted to explore their views and experiences and inform the ethical analysis.
Results
Children (10–13 years old) and adolescents (14–18 years old) reported good experiences with the stimulation. Next to financial incentives, main motives to participate in the study were curiosity and the possibility to help develop treatments for children affected by neurological disorders. They could also see a potential of using tDCS in a non-medical setting, especially regarding the provision of equal opportunity, e.g. in education. Parents also presented a positive attitude towards tDCS and their children participation in the basic research study. Nevertheless, their understanding of tDCS was rather poor. Even though many of them understood the techniques, they often did not see the link between the (current) lack of side effects and an absence of longitudinal studies. Parents were also cautious about using tDCS for non-medical/enhancement purposes.
Conclusions
The study findings show a need for more transparent information about the state of the art of tDCS, its function and what it might be able to offer, especially considering the good acceptability of tDCS.
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14
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Fineberg NA, Cinosi E, Smith MVA, Busby AD, Wellsted D, Huneke NTM, Garg K, Aslan IH, Enara A, Garner M, Gordon R, Hall N, Meron D, Robbins TW, Wyatt S, Pellegrini L, Baldwin DS. Feasibility, acceptability and practicality of transcranial stimulation in obsessive compulsive symptoms (FEATSOCS): A randomised controlled crossover trial. Compr Psychiatry 2023; 122:152371. [PMID: 36709558 DOI: 10.1016/j.comppsych.2023.152371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a non-invasive form of neurostimulation with potential for development as a self-administered intervention. It has shown promise as a safe and effective treatment for obsessive compulsive disorder (OCD) in a small number of studies. The two most favourable stimulation targets appear to be the left orbitofrontal cortex (L-OFC) and the supplementary motor area (SMA). We report the first study to test these targets head-to-head within a randomised sham-controlled trial. Our aim was to inform the design of future clinical research studies, by focussing on the acceptability and safety of the intervention, feasibility of recruitment, adherence to and tolerability of tDCS, and the size of any treatment-effect. METHODS FEATSOCS was a randomised, double-blind, sham-controlled, cross-over, multicentre study. Twenty adults with DSM-5-defined OCD were randomised to treatment, comprising three courses of clinic-based tDCS (SMA, L-OFC, Sham), randomly allocated and delivered in counterbalanced order. Each course comprised four 20-min 2 mA stimulations, delivered over two consecutive days, separated by a 'washout' period of at least four weeks. Assessments were carried out by raters who were blind to stimulation-type. Clinical outcomes were assessed before, during, and up to four weeks after stimulation. Patient representatives with lived experience of OCD were actively involved at all stages. RESULTS Clinicians showed willingness to recruit participants and recruitment to target was achieved. Adherence to treatment and study interventions was generally good, with only two dropouts. There were no serious adverse events, and adverse effects which did occur were transient and mostly mild in intensity. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores were numerically improved from baseline to 24 h after the final stimulation across all intervention groups but tended to worsen thereafter. The greatest effect size was seen in the L-OFC arm, (Cohen's d = -0.5 [95% CI -1.2 to 0.2] versus Sham), suggesting this stimulation site should be pursued in further studies. Additional significant sham referenced improvements in secondary outcomes occurred in the L-OFC arm, and to a lesser extent with SMA stimulation. CONCLUSIONS tDCS was acceptable, practicable to apply, well-tolerated and appears a promising potential treatment for OCD. The L-OFC represents the most promising target based on clinical changes, though the effects on OCD symptoms were not statistically significant compared to sham. SMA stimulation showed lesser signs of promise. Further investigation of tDCS in OCD is warranted, to determine the optimal stimulation protocol (current, frequency, duration), longer-term effectiveness and brain-based mechanisms of effect. If efficacy is substantiated, consideration of home-based approaches represents a rational next step. TRIAL REGISTRATION ISRCTN17937049. https://doi.org/10.1186/ISRCTN17937049.
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Affiliation(s)
- Naomi A Fineberg
- Hertfordshire Partnership NHS University Foundation Trust, Highly Specialised OCD and BDD Service, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK; Clinical Medical School, University of Cambridge, UK
| | - Eduardo Cinosi
- Hertfordshire Partnership NHS University Foundation Trust, Highly Specialised OCD and BDD Service, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Megan V A Smith
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK.
| | - Amanda D Busby
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - David Wellsted
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Nathan T M Huneke
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Southern Health NHS Foundation Trust, Tatchbury Mount, Southampton, UK
| | - Kabir Garg
- The Lishman Unit, South London and Maudsley NHS Foundation Trust, UK
| | - Ibrahim H Aslan
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Arun Enara
- Camden and Islington NHS Foundation Trust, London, UK
| | - Matthew Garner
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; School of Psychology, University of Southampton, Southampton, UK
| | - Robert Gordon
- Southern Health NHS Foundation Trust, Tatchbury Mount, Southampton, UK
| | - Natalie Hall
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Daniel Meron
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Somerset NHS Foundation Trust, Taunton, Somerset, UK
| | | | - Solange Wyatt
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Luca Pellegrini
- Hertfordshire Partnership NHS University Foundation Trust, Highly Specialised OCD and BDD Service, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Southern Health NHS Foundation Trust, Tatchbury Mount, Southampton, UK; University Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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15
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Han LT, Cohen MS, He LK, Green LM, Knowlton BJ, Castel AD, Rissman J. Establishing a causal role for left ventrolateral prefrontal cortex in value-directed memory encoding with high-definition transcranial direct current stimulation. Neuropsychologia 2023; 181:108489. [PMID: 36669696 DOI: 10.1016/j.neuropsychologia.2023.108489] [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: 09/29/2022] [Revised: 12/23/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
One critical approach for promoting the efficiency of memory is to adopt selective encoding strategies to prioritize more valuable information. Past neuroimaging studies have shown that value-directed modulation of verbal memory depends heavily on the engagement of left-lateralized semantic processing regions, particularly in the ventrolateral prefrontal cortex (VLPFC). In the present study, we used high-definition transcranial direct current stimulation (HD-tDCS) to seek evidence for a causal role of left VLPFC in supporting the memory advantage for high-value items. Three groups of healthy young adult participants were presented with lists of words to remember, with each word accompanied by an arbitrarily assigned point value. During the first session, all participants received sham stimulation as they encoded five lists of 30 words each. Two of these lists were immediately tested with free recall, with feedback given to allow participants to develop metacognitive insight and strategies to maximize their point total. The second session had the exact same structure as the first, but the groups differed in whether they received continued sham stimulation (N = 22) or anodal stimulation of the left VLPFC (N = 21) or right VLPFC (N = 20). Those lists not tested with immediate recall were tested with recognition judgments after a one-day delay. Since no brain stimulation was applied during this Day 2 test, any performance differences can be attributed to the effects of stimulation on Day 1 encoding processes. Anodal stimulation of left VLPFC significantly boosted participants' memory encoding selectivity. In comparison, no such effect was seen in participants who received right VLPFC or sham stimulation. Estimates of recollection- and familiarity-based responding revealed that left VLPFC stimulation specifically amplified the effects of item value on recollection. These results demonstrate a causal role for left VLPFC in the implementation of selective value-directed encoding strategies, putatively by boosting deep semantic processing of high-value words. Our findings also provide further evidence on the hemispheric lateralization of value-directed verbal memory encoding.
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Affiliation(s)
- Linfeng Tony Han
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, 90095, USA; Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Psychology, Tsinghua University, Beijing, 100084, China
| | - Michael S Cohen
- Department of Psychology, University of Chicago, Chicago, IL, 60637, USA
| | - Liqin Ken He
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Laura M Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Barbara J Knowlton
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Alan D Castel
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jesse Rissman
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, 90095, USA.
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16
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Turnbull A, Anthony M, Tadin D, Porsteinsson AP, Heffner K, Lin FV. Effect of online tDCS to left somatomotor cortex on neuropsychiatric symptoms among older adults at risk for dementia. Cortex 2023; 159:131-141. [PMID: 36623419 PMCID: PMC9931675 DOI: 10.1016/j.cortex.2022.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/28/2022] [Accepted: 10/19/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) in mild cognitive impairment (MCI) cause distress to patients and caregivers, and accelerate progression to dementia. Transcranial direct current stimulation (tDCS) is a promising non-invasive treatment for NPS. OBJECTIVE/HYPOTHESIS This pilot study assessed behavioral and neural effects of a 4-week anodal tDCS intervention targeting left sensorimotor cortex (LSMC: left precentral/postcentral gyri) during visual attention (compared to online sham tDCS), in 40 older adults (24 females, mean age = 71) with MCI. METHODS A phase 0 double-blinded randomized control trial was conducted. NPS (patient-reported mood symptoms plus a caregiver-reported questionnaire) and fMRI were measured at baseline and immediately post-intervention. RESULTS Generalized Estimating Equations found no significant group by time interactions for either NPS measure. However, there was evidence of decreased patient-reported NPS (Wald's χ2 = 3.80, p = .051), decreased LSMC activation during visual attention (Wald's χ2 = 2.93, p = .087), and increased LSMC-amygdala resting-state functional connectivity (rsFC; Wald's χ2 = 3.13, p = .077) in intervention group from pre-to post-intervention. Decrease in LSMC activation (Wald's χ2 = 9.20, p = .002) and increase in LSMC-amygdala rsFC (Wald's χ2 = 4.72, p = .030) related to decreased patient-reported NPS. Increased positive valence across sessions was significantly associated with intervention-related NPS improvement (Wald's χ2 = 22.92, p < .001). There were no findings for caregiver-reported NPS. Effects were stronger for left postcentral compared to left precentral gyrus. CONCLUSION We found tentative evidence that tDCS applied to LSMC during visual attention in older adults with MCI improved NPS via changes in LSMC activation and LSMC-amygdala rsFC, suggesting improved emotion regulation. Patient-reported NPS was more sensitive to these changes than caregiver-reports, and effects were strongest for left postcentral gyrus. Follow-up studies should perform precise mechanistic investigation and efficacy testing.
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Affiliation(s)
- Adam Turnbull
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, CA, USA; Departments of Brain and Cognitive Sciences, Neuroscience and Ophthalmology, University of Rochester, NY, USA.
| | - Mia Anthony
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, CA, USA; Departments of Brain and Cognitive Sciences, Neuroscience and Ophthalmology, University of Rochester, NY, USA
| | - Duje Tadin
- Departments of Brain and Cognitive Sciences, Neuroscience and Ophthalmology, University of Rochester, NY, USA
| | - Anton P Porsteinsson
- Departments of Brain and Cognitive Sciences, Neuroscience and Ophthalmology, University of Rochester, NY, USA; Department of Psychiatry, University of Rochester Medical Center, NY, USA
| | - Kathi Heffner
- Department of Psychiatry, University of Rochester Medical Center, NY, USA; Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, NY, USA; Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, NY, USA
| | - Feng V Lin
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, CA, USA
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17
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Ziogas A, Habermeyer E, Santtila P, Poeppl TB, Mokros A. Neuroelectric Correlates of Human Sexuality: A Review and Meta-Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:497-596. [PMID: 32016814 DOI: 10.1007/s10508-019-01547-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 07/17/2019] [Accepted: 09/04/2019] [Indexed: 05/15/2023]
Abstract
Many reviews on sexual arousal in humans focus on different brain imaging methods and behavioral observations. Although neurotransmission in the brain is mainly performed through electrochemical signals, there are no systematic reviews of the electrophysiological correlates of sexual arousal. We performed a systematic search on this subject and reviewed 255 studies including various electrophysiological methods. Our results show how neuroelectric signals have been used to investigate genital somatotopy as well as basic genital physiology during sexual arousal and how cortical electric signals have been recorded during orgasm. Moreover, experiments on the interactions of cognition and sexual arousal in healthy subjects and in individuals with abnormal sexual preferences were analyzed as well as case studies on sexual disturbances associated with diseases of the nervous system. In addition, 25 studies focusing on brain potentials during the interaction of cognition and sexual arousal were eligible for meta-analysis. The results showed significant effect sizes for specific brain potentials during sexual stimulation (P3: Cohen's d = 1.82, N = 300, LPP: Cohen's d = 2.30, N = 510) with high heterogeneity between the combined studies. Taken together, our review shows how neuroelectric methods can consistently differentiate sexual arousal from other emotional states.
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Affiliation(s)
- Anastasios Ziogas
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Alleestrasse 61A, 8462, Rheinau, Switzerland.
| | - Elmar Habermeyer
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Pekka Santtila
- Department of Arts & Sciences, New York University-Shanghai, Shanghai, China
| | - Timm B Poeppl
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, RWTH Aachen University, Aachen, Germany
| | - Andreas Mokros
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Faculty of Psychology, Fern Universität in Hagen (University of Hagen), Hagen, Germany
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18
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Moses TE, Gray E, Mischel N, Greenwald MK. Effects of neuromodulation on cognitive and emotional responses to psychosocial stressors in healthy humans. Neurobiol Stress 2023; 22:100515. [PMID: 36691646 PMCID: PMC9860364 DOI: 10.1016/j.ynstr.2023.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
Physiological and psychological stressors can exert wide-ranging effects on the human brain and behavior. Research has improved understanding of how the sympatho-adreno-medullary (SAM) and hypothalamic-pituitary-adrenocortical (HPA) axes respond to stressors and the differential responses that occur depending on stressor type. Although the physiological function of SAM and HPA responses is to promote survival and safety, exaggerated psychobiological reactivity can occur in psychiatric disorders. Exaggerated reactivity may occur more for certain types of stressors, specifically, psychosocial stressors. Understanding stressor effects and how the body regulates these responses can provide insight into ways that psychobiological reactivity can be modulated. Non-invasive neuromodulation is one way that responding to stressors may be altered; research into these interventions may provide further insights into the brain circuits that modulate stress reactivity. This review focuses on the effects of acute psychosocial stressors and how neuromodulation might be effective in altering stress reactivity. Although considerable research into stress interventions focuses on treating pathology, it is imperative to first understand these mechanisms in non-clinical populations; therefore, this review will emphasize populations with no known pathology and consider how these results may translate to those with psychiatric pathologies.
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Affiliation(s)
| | | | | | - Mark K. Greenwald
- Corresponding author. Department of Psychiatry and Behavioral Neurosciences, Tolan Park Medical Building, 3901 Chrysler Service Drive, Suite 2A, Detroit, MI, 48201, USA.
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Westwood SJ, Criaud M, Lam SL, Lukito S, Wallace-Hanlon S, Kowalczyk OS, Kostara A, Mathew J, Agbedjro D, Wexler BE, Cohen Kadosh R, Asherson P, Rubia K. Transcranial direct current stimulation (tDCS) combined with cognitive training in adolescent boys with ADHD: a double-blind, randomised, sham-controlled trial. Psychol Med 2023; 53:497-512. [PMID: 34225830 PMCID: PMC9899574 DOI: 10.1017/s0033291721001859] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/19/2021] [Accepted: 04/22/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) could be a side-effect-free alternative to psychostimulants in attention-deficit/hyperactivity disorder (ADHD). Although there is limited evidence for clinical and cognitive effects, most studies were small, single-session and stimulated left dorsolateral prefrontal cortex (dlPFC). No sham-controlled study has stimulated the right inferior frontal cortex (rIFC), which is the most consistently under-functioning region in ADHD, with multiple anodal-tDCS sessions combined with cognitive training (CT) to enhance effects. Thus, we investigated the clinical and cognitive effects of multi-session anodal-tDCS over rIFC combined with CT in double-blind, randomised, sham-controlled trial (RCT, ISRCTN48265228). METHODS Fifty boys with ADHD (10-18 years) received 15 weekday sessions of anodal- or sham-tDCS over rIFC combined with CT (20 min, 1 mA). ANCOVA, adjusting for baseline measures, age and medication status, tested group differences in clinical and ADHD-relevant executive functions at posttreatment and after 6 months. RESULTS ADHD-Rating Scale, Conners ADHD Index and adverse effects were significantly lower at post-treatment after sham relative to anodal tDCS. No other effects were significant. CONCLUSIONS This rigorous and largest RCT of tDCS in adolescent boys with ADHD found no evidence of improved ADHD symptoms or cognitive performance following multi-session anodal tDCS over rIFC combined with CT. These findings extend limited meta-analytic evidence of cognitive and clinical effects in ADHD after 1-5 tDCS sessions over mainly left dlPFC. Given that tDCS is commercially and clinically available, the findings are important as they suggest that rIFC stimulation may not be indicated as a neurotherapy for cognitive or clinical remediation for ADHD.
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Affiliation(s)
- Samuel J. Westwood
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | - Marion Criaud
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | - Sheut-Ling Lam
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | - Steve Lukito
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | | | - Olivia S. Kowalczyk
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
- Department of Neuroimaging, King's College London, London, UK
| | - Afroditi Kostara
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | - Joseph Mathew
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | | | - Bruce E. Wexler
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Roi Cohen Kadosh
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip Asherson
- Social Genetic & Developmental Psychiatry, King's College London, London, UK
| | - Katya Rubia
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
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20
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Becker CR, Milad MR. Contemporary Approaches Toward Neuromodulation of Fear Extinction and Its Underlying Neural Circuits. Curr Top Behav Neurosci 2023; 64:353-387. [PMID: 37658219 DOI: 10.1007/7854_2023_442] [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: 09/03/2023]
Abstract
Neuroscience and neuroimaging research have now identified brain nodes that are involved in the acquisition, storage, and expression of conditioned fear and its extinction. These brain regions include the ventromedial prefrontal cortex (vmPFC), dorsal anterior cingulate cortex (dACC), amygdala, insular cortex, and hippocampus. Psychiatric neuroimaging research shows that functional dysregulation of these brain regions might contribute to the etiology and symptomatology of various psychopathologies, including anxiety disorders and post traumatic stress disorder (PTSD) (Barad et al. Biol Psychiatry 60:322-328, 2006; Greco and Liberzon Neuropsychopharmacology 41:320-334, 2015; Milad et al. Biol Psychiatry 62:1191-1194, 2007a, Biol Psychiatry 62:446-454, b; Maren and Quirk Nat Rev Neurosci 5:844-852, 2004; Milad and Quirk Annu Rev Psychol 63:129, 2012; Phelps et al. Neuron 43:897-905, 2004; Shin and Liberzon Neuropsychopharmacology 35:169-191, 2009). Combined, these findings indicate that targeting the activation of these nodes and modulating their functional interactions might offer an opportunity to further our understanding of how fear and threat responses are formed and regulated in the human brain, which could lead to enhancing the efficacy of current treatments or creating novel treatments for PTSD and other psychiatric disorders (Marin et al. Depress Anxiety 31:269-278, 2014; Milad et al. Behav Res Ther 62:17-23, 2014). Device-based neuromodulation techniques provide a promising means for directly changing or regulating activity in the fear extinction network by targeting functionally connected brain regions via stimulation patterns (Raij et al. Biol Psychiatry 84:129-137, 2018; Marković et al. Front Hum Neurosci 15:138, 2021). In the past ten years, notable advancements in the precision, safety, comfort, accessibility, and control of administration have been made to the established device-based neuromodulation techniques to improve their efficacy. In this chapter we discuss ten years of progress surrounding device-based neuromodulation techniques-Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), Magnetic Seizure Therapy (MST), Transcranial Focused Ultrasound (TUS), Deep Brain Stimulation (DBS), Vagus Nerve Stimulation (VNS), and Transcranial Electrical Stimulation (tES)-as research and clinical tools for enhancing fear extinction and treating PTSD symptoms. Additionally, we consider the emerging research, current limitations, and possible future directions for these techniques.
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Affiliation(s)
- Claudia R Becker
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Mohammed R Milad
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
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21
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Han J, Choi KM, Yang C, Kim HS, Park SS, Lee SH. Treatment efficacy of tDCS and predictors of treatment response in patients with post-traumatic stress disorder. J Affect Disord 2022; 318:357-363. [PMID: 36055537 DOI: 10.1016/j.jad.2022.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/31/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although transcranial direct stimulation (tDCS) has been proposed as an alternative treatment option for various psychiatric disorders, there is inconsistent information regarding the treatment effects of tDCS for patients with post-traumatic stress disorder (PTSD). This study aimed to investigate the tDCS efficacy and identify predictors of treatment response to tDCS in patients with PTSD. METHOD Fifty-one patients received 10 sessions of tDCS involving the position of the anode over the F3 area and cathode over the F4 as a condition of 2.0 mA and 20 min duration. Digit span test and 10 questionnaires (Clinician-Administered PTSD Scale (CAPS), Cognitive Emotion Regulation Questionnaire (CERQ), Multidimensional Experiential Avoidance Questionnaire (MEAQ), etc.) were used to measure tDCS effects on PTSD symptoms and identify predictors of response to tDCS. RESULTS 1) 50.9 % of patients had a significant reduction in the frequency and severity of PTSD symptoms, 2) PTSD-related symptoms such as depression, anxiety, rumination, and quality of life were significantly improved, 3) baseline scores on rumination and digit span test significantly predicted treatment response to tDCS. LIMITATIONS This study was open design without a sham control group. Also, the patients' medications were not controlled. CONCLUSION This study highlighted the efficacy of frontal tDCS for the treatment of patients with PTSD and identified rumination and digit span as favorable predictive factors for the outcomes of tDCS.
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Affiliation(s)
- Jungwon Han
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Psychology, Sogang University, Seoul, Republic of Korea
| | - Kang-Min Choi
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; School of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
| | - Chaeyeon Yang
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Psychology, Sogang University, Seoul, Republic of Korea
| | - Hyang Sook Kim
- Department of Psychology, Sogang University, Seoul, Republic of Korea
| | | | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, Republic of Korea; Bwave Inc., Juhwa-ro, Goyang 10380, Republic of Korea..
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22
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Boosting psychological change: Combining non-invasive brain stimulation with psychotherapy. Neurosci Biobehav Rev 2022; 142:104867. [PMID: 36122739 DOI: 10.1016/j.neubiorev.2022.104867] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022]
Abstract
Mental health disorders and substance use disorders are a leading cause of morbidity and mortality worldwide, and one of the most important challenges for public health systems. While evidence-based psychotherapy is generally pursued to address mental health challenges, psychological change is often hampered by non-adherence to treatments, relapses, and practical barriers (e.g., time, cost). In recent decades, Non-invasive brain stimulation (NIBS) techniques have emerged as promising tools to directly target dysfunctional neural circuitry and promote long-lasting plastic changes. While the therapeutic efficacy of NIBS protocols for mental illnesses has been established, neuromodulatory interventions might also be employed to support the processes activated by psychotherapy. Indeed, combining psychotherapy with NIBS might help tailor the treatment to the patient's unique characteristics and therapeutic goal, and would allow more direct control of the neuronal changes induced by therapy. Herein, we overview emerging evidence on the use of NIBS to enhance the psychotherapeutic effect, while highlighting the next steps in advancing clinical and research methods toward personalized intervention approaches.
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23
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Almeida-Antunes N, Vasconcelos M, Crego A, Rodrigues R, Sampaio A, López-Caneda E. Forgetting Alcohol: A Double-Blind, Randomized Controlled Trial Investigating Memory Inhibition Training in Young Binge Drinkers. Front Neurosci 2022; 16:914213. [PMID: 35844233 PMCID: PMC9278062 DOI: 10.3389/fnins.2022.914213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Binge Drinking (BD) has been associated with altered inhibitory control and augmented alcohol-cue reactivity. Memory inhibition (MI), the ability to voluntarily suppress unwanted thoughts/memories, may lead to forgetting of memories in several psychiatric conditions. However, despite its potential clinical implications, no study to date has explored the MI abilities in populations with substance misuse, such as binge drinkers (BDs). Method This study—registered in the NIH Clinical Trials Database (ClinicalTrials.gov identifier: NCT05237414)—aims firstly to examine the behavioral and electroencephalographic (EEG) correlates of MI among college BDs. For this purpose, 45 BDs and 45 age-matched non/low-drinkers (50% female) will be assessed by EEG while performing the Think/No-Think Alcohol task, a paradigm that evaluates alcohol-related MI. Additionally, this work aims to evaluate an alcohol-specific MI intervention protocol using cognitive training (CT) and transcranial direct current stimulation (tDCS) while its effects on behavioral and EEG outcomes are assessed. BDs will be randomly assigned to one MI training group: combined [CT and verum tDCS applied over the right dorsolateral prefrontal cortex (DLPFC)], cognitive (CT and sham tDCS), or control (sham CT and sham tDCS). Training will occur in three consecutive days, in three sessions. MI will be re-assessed in BDs through a post-training EEG assessment. Alcohol use and craving will be measured at the first EEG assessment, and both 10-days and 3-months post-training. In addition, behavioral and EEG data will be collected during the performance of an alcohol cue reactivity (ACR) task, which evaluates attentional bias toward alcoholic stimuli, before, and after the MI training sessions. Discussion This study protocol will provide the first behavioral and neurofunctional MI assessment in BDs. Along with poor MI abilities, BDs are expected to show alterations in event-related potentials and functional connectivity patterns associated with MI. Results should also demonstrate the effectiveness of the protocol, with BDs exhibiting an improved capacity to suppress alcohol-related memories after both combined and cognitive training, along with a reduction in alcohol use and craving in the short/medium-term. Collectively, these findings might have major implications for the understanding and treatment of alcohol misuse. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [NCT05237414].
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Affiliation(s)
- Natália Almeida-Antunes
- Psychological Neuroscience Laboratory, Psychology Research Center, University of Minho, Braga, Portugal
| | - Margarida Vasconcelos
- Psychological Neuroscience Laboratory, Psychology Research Center, University of Minho, Braga, Portugal
| | - Alberto Crego
- Psychological Neuroscience Laboratory, Psychology Research Center, University of Minho, Braga, Portugal
| | - Rui Rodrigues
- Psychological Neuroscience Laboratory, Psychology Research Center, University of Minho, Braga, Portugal
| | - Adriana Sampaio
- Psychological Neuroscience Laboratory, Psychology Research Center, University of Minho, Braga, Portugal
| | - Eduardo López-Caneda
- Psychological Neuroscience Laboratory, Psychology Research Center, University of Minho, Braga, Portugal
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24
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Olgiati E, Malhotra PA. Using non-invasive transcranial direct current stimulation for neglect and associated attentional deficits following stroke. Neuropsychol Rehabil 2022; 32:732-763. [PMID: 32892712 DOI: 10.1080/09602011.2020.1805335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neglect is a disabling neuropsychological syndrome that is frequently observed following right-hemispheric stroke. Affected individuals often present with multiple attentional deficits, ranging from reduced orienting towards contralesional space to a generalized impairment in maintaining attention over time. Although a degree of spontaneous recovery occurs in most patients, in some individuals this condition can be treatment-resistant with prominent ongoing non-spatial deficits. Further, there is a large inter-individual variability in response to different therapeutic approaches. Given its potential to alter neuronal excitability and affect neuroplasticity, non-invasive brain stimulation is a promising tool that could potentially be utilized to facilitate recovery. However, there are many outstanding questions regarding its implementation in this heterogeneous patient group. Here we provide a critical overview of the available evidence on the use of non-invasive electrical brain stimulation, focussing on transcranial direct current stimulation (tDCS), to improve neglect and associated attentional deficits after right-hemispheric stroke. At present, there is insufficient robust evidence supporting the clinical use of tDCS to alleviate symptoms of neglect. Future research would benefit from careful study design, enhanced precision of electrical montages, multi-modal approaches exploring predictors of response, tailored dose-control applications and increased efforts to evaluate standalone tDCS versus its incorporation into combination therapy.
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Affiliation(s)
- Elena Olgiati
- Department of Brain Sciences, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Paresh A Malhotra
- Department of Brain Sciences, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK.,UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, London, UK
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25
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Westwood SJ, Bozhilova N, Criaud M, Lam SL, Lukito S, Wallace-Hanlon S, Kowalczyk OS, Kostara A, Mathew J, Wexler BE, Kadosh RC, Asherson P, Rubia K. The effect of transcranial direct current stimulation (tDCS) combined with cognitive training on EEG spectral power in adolescent boys with ADHD: A double-blind, randomized, sham-controlled trial. IBRO Neurosci Rep 2022; 12:55-64. [PMID: 35746969 PMCID: PMC9210460 DOI: 10.1016/j.ibneur.2021.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/19/2021] [Indexed: 12/19/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a possible alternative to psychostimulants in Attention-Deficit/Hyperactivity Disorder (ADHD), but its mechanisms of action in children and adolescents with ADHD are poorly understood. We conducted the first 15-session, sham-controlled study of anodal tDCS over right inferior frontal cortex (rIFC) combined with cognitive training (CT) in 50 children/adolescents with ADHD. We investigated the mechanisms of action on resting and Go/No-Go Task-based QEEG measures in a subgroup of 23 participants with ADHD (n, sham = 10; anodal tDCS = 13). We failed to find a significant sham versus anodal tDCS group differences in QEEG spectral power during rest and Go/No-Go Task performance, a correlation between QEEG and Go/No-Go Task performance, and changes in clinical and cognitive measures. These findings extend the non-significant clinical and cognitive effects in our sample of 50 children/adolescents with ADHD. Given that the subgroup of 23 participants would have been underpowered, the interpretation of our findings is limited and should be used as a foundation for future investigations. Larger, adequately powered randomized controlled trials should explore different protocols titrated to the individual and using comprehensive measures to assess cognitive, clinical, and neural effects of tDCS and its underlying mechanisms of action in ADHD.
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Affiliation(s)
- Samuel J. Westwood
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- School of Psychology, University of Wolverhampton, Wolverhampton WV1 1LY UK
- Department of Psychology, School of Social Science, University of Westminster, London W1W 6UW, UK
- Correspondence to: Department of Child and Adolescent Psychiatry - PO85 Institute of Psychiatry, Psychology and Neuroscience King’s College London, 16 De Crespigny Park, London SE5 8AF, UK.
| | - Natali Bozhilova
- Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- School of Psychology, University of Surrey, Guildford GU2 7XH, UK
- Correspondence to: School of Psychology Elizabeth Fry Building, University of Surrey, Guildford GU2 7XH, UK.
| | - Marion Criaud
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Sheut-Ling Lam
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Steve Lukito
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Sophie Wallace-Hanlon
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- School of Psychology, University of Surrey, Guildford GU2 7XH, UK
| | - Olivia S. Kowalczyk
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Afroditi Kostara
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Joseph Mathew
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Bruce E. Wexler
- Department of Psychiatry, Yale University School of Medicine, 06520–8096, USA
| | - Roi Cohen Kadosh
- School of Psychology, University of Surrey, Guildford GU2 7XH, UK
| | - Philip Asherson
- Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
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26
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Lavezzi GD, Galan SS, Andersen H, Tomer D, Cacciamani L. The Effects of tDCS on Object Perception: A Systematic Review and Meta-Analysis. Behav Brain Res 2022; 430:113927. [DOI: 10.1016/j.bbr.2022.113927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/21/2022] [Accepted: 05/11/2022] [Indexed: 11/02/2022]
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27
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Strang CE, Amthor FR. Effects of tACS-Like Electrical Stimulation on Off- and On-Off Center Retinal Ganglion Cells: Part II. Eye Brain 2022; 14:17-33. [PMID: 35115857 PMCID: PMC8800591 DOI: 10.2147/eb.s313090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Transcranial alternating current stimulation (tACS) is used as a brain stimulation mechanism to enhance learning, ameliorate some psychiatric disorders, and modify behavior. This study assessed the effects of near threshold tACS-like currents on Off-center and On-Off retinal ganglion cell responsiveness in the rabbit retina eyecup preparation as a model for central nervous system effects. MATERIALS AND METHODS We made extracellular recordings in the isolated rabbit eyecup preparation using single electrodes and microelectrode arrays to measure light-evoked spike responses in different classes of Off-center and On-Off retinal ganglion cells before, during, and after brief applications of alternating currents of 1-2 microamperes, at frequencies of 10, 20, 30, and 40 Hz. RESULTS tACS application sculpted the light-evoked response profiles without directly driving spiking activity of the 20 Off-center and On-Off ganglion cells we recorded from. During tACS application, Off responses were significantly enhanced for 6 cells and significantly suppressed for 14 cells, but after tACS application, Off responses were significantly enhanced for 7 cells and suppressed for 12 cells. The Off responses of the remaining two cells returned to baseline. On responses were less affected during and after tACS. CONCLUSION tACS sculpts Off-center and On-Off retinal ganglion cell responsiveness. The dissimilarity of effects in different cells within the same class and the differential effects on the On and Off components of the light response within the same cell are consistent with the hypothesis that tACS acts at threshold on amacrine cells in the inner plexiform layer.
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Affiliation(s)
- Christianne E Strang
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, 35294-1170, USA
| | - Franklin R Amthor
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, 35294-1170, USA
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28
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Amthor FR, Strang CE. Effects of tACS-Like Electrical Stimulation on Correlated Firing of Retinal Ganglion Cells: Part III. Eye Brain 2022; 14:1-15. [PMID: 35046742 PMCID: PMC8763268 DOI: 10.2147/eb.s313161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023] Open
Abstract
Purpose Transcranial alternating current stimulation (tACS) is a stimulation protocol used for learning enhancement and mitigation of cognitive dysfunction. Correlated firing has been postulated to be a meta-code that links neuronal spike responses associated with a single entity and may be an important component of high-level cognitive functions. Thus, changes in the covariance firing structure of CNS neurons such as retinal ganglion cells are one potential mechanism by which tACS can exert its effects. Materials and Methods We used microelectrode arrays to record light-evoked spike responses of 24 retinal ganglion cells in 7 rabbit eyecup preparations and analyzed the covariance between 30 pairs of neighboring retinal ganglion cells before, during, and after 10-minute application of alternating currents of 1 microampere at 10 or 20 Hz. Results tACS stimulation significantly changed the covariance structure of correlated firing in 60% of simultaneously recorded retinal ganglion cells. Application of tACS in the retinal preparation increased cross-covariance in 26% of cell pairs, an effect usually associated with increased light-evoked ganglion cell firing. tACS associated decreases in cross-covariance occurred in 37% of cell pairs. Increased covariance was more common in response to the first, 10-minute application of tACS in isolated retina preparation. Changes in covariance were rare after repeated stimulation, and more likely to result in decreased covariance. Conclusion Retinal ganglion cell correlated firing is modulated by 1 microampere tACS currents showing that electrical stimulation can significantly and persistently change the structure of the correlated firing of simultaneously recorded rabbit retinal ganglion cells.
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Affiliation(s)
- Franklin R Amthor
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Christianne E Strang
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
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29
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Arulpragasam AR, van 't Wout-Frank M, Barredo J, Faucher CR, Greenberg BD, Philip NS. Low Intensity Focused Ultrasound for Non-invasive and Reversible Deep Brain Neuromodulation-A Paradigm Shift in Psychiatric Research. Front Psychiatry 2022; 13:825802. [PMID: 35280168 PMCID: PMC8907584 DOI: 10.3389/fpsyt.2022.825802] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/18/2022] [Indexed: 01/15/2023] Open
Abstract
This article describes an emerging non-invasive neuromodulatory technology, called low intensity focused ultrasound (LIFU). This technology is potentially paradigm shifting as it can deliver non-invasive and reversible deep brain neuromodulation through acoustic sonication, at millimeter precision. Low intensity focused ultrasound's spatial precision, yet non-invasive nature sets it apart from current technologies, such as transcranial magnetic or electrical stimulation and deep brain stimulation. Additionally, its reversible effects allow for the causal study of deep brain regions implicated in psychiatric illness. Studies to date have demonstrated that LIFU can safely modulate human brain activity at cortical and subcortical levels. Due to its novelty, most researchers and clinicians are not aware of the potential applications and promise of this technique, underscoring the need for foundational papers to introduce the community to LIFU. This mini-review and synthesis of recent advances examines several key papers on LIFU administered to humans, describes the population under study, parameters used, and relevant findings that may guide future research. We conclude with a concise overview of some of the more pressing questions to date, considerations when interpreting new data from an emerging field, and highlight the opportunities and challenges in this exciting new area of study.
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Affiliation(s)
- Amanda R Arulpragasam
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Mascha van 't Wout-Frank
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States.,COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, United States
| | - Jennifer Barredo
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States.,COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, United States
| | - Christiana R Faucher
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States
| | - Benjamin D Greenberg
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States.,COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, United States
| | - Noah S Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States.,COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, United States
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Gibson BC, Votaw VR, Stein ER, Clark VP, Claus E, Witkiewitz K. Transcranial Direct Current Stimulation Provides no Additional Benefit to Improvements in Self-Reported Craving Following Mindfulness-Based Relapse Prevention. Mindfulness (N Y) 2022; 13:92-103. [PMID: 35833199 PMCID: PMC9272998 DOI: 10.1007/s12671-021-01768-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 01/03/2023]
Abstract
Objectives Mindfulness-Based Relapse Prevention (MBRP) and transcranial direct current stimulation (tDCS) have each demonstrated efficacy in improving outcomes in those with alcohol use disorder (AUD), however a recent study that combined MBRP with tDCS found tDCS provided no additional benefit to MBRP for AUD. Differences in treatment adherence between active versus sham tDCS groups may have contributed to this result. The current study examined whether treatment adherence interacted with tDCS condition in predicting post-treatment mindfulness and craving. Methods This study was a secondary data analysis from a randomized sham-controlled trial comparing MBRP paired with tDCS. Linear regression analyses were conducted examining the interaction between tDCS condition and two measures of treatment adherence (i.e., number of groups attended, number of tDCS administrations) on post-treatment mindfulness and craving. Results There was no effect of treatment adherence by tDCS condition in predicting mindfulness, however the interaction between treatment adherence and tDCS condition significantly predicted post-treatment craving. There was a significant negative association between treatment adherence and post-treatment craving in the sham group, but there was no association in the active tDCS group. Conclusions MBRP coupled with sham stimulation led to significant reductions in self-reported craving when patients attended more sessions and received a greater number of sham tDCS administrations, while no relationship was observed between treatment adherence and craving among those who received active tDCS. This result provides tentative evidence that, rather than improve the effects of MBRP on craving, this active tDCS protocol provides no additional benefit to MBRP in reducing craving. Pre-registration This study was registered with clinicaltrials.gov (NCT02861807).
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Affiliation(s)
- Benjamin C. Gibson
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- The Mind Research Network, Department of Translational Neuroscience, 1101 Yale Blvd. NE, Albuquerque, NM 87106
| | - Victoria R. Votaw
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- Center on Alcohol, Substance use, And Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106
| | - Elena R. Stein
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- Center on Alcohol, Substance use, And Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106
| | - Vincent P. Clark
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- The Mind Research Network, Department of Translational Neuroscience, 1101 Yale Blvd. NE, Albuquerque, NM 87106
| | - Eric Claus
- The Mind Research Network, Department of Translational Neuroscience, 1101 Yale Blvd. NE, Albuquerque, NM 87106
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA 16802
| | - Katie Witkiewitz
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- Center on Alcohol, Substance use, And Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106
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Flynn M, Campbell I, Schmidt U. Does concurrent self-administered transcranial direct current stimulation and attention bias modification training improve symptoms of binge eating disorder? Protocol for the TANDEM feasibility randomized controlled trial. Front Psychiatry 2022; 13:949246. [PMID: 35990072 PMCID: PMC9382293 DOI: 10.3389/fpsyt.2022.949246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Binge eating disorder (BED) is a common and disabling problem associated with impaired cognitive control. Preliminary studies show that brain-directed treatments, including transcranial direct current stimulation (tDCS) and attention bias modification training (ABMT), improve cognitive control and alleviate symptoms of BED. When combined, tDCS may enhance the effects of ABMT, and vice versa, thereby improving treatment outcomes. METHODS This protocol describes a feasibility single-blind randomized sham-controlled trial of concurrent self-administered tDCS and ABMT in adults with BED (The TANDEM Trial). Eighty adults with BED will be randomly assigned to one of four groups: ABMT with real or sham self-administered tDCS, ABMT only, or waiting list control. In the treatment arms, participants will complete 10-sessions of their allocated intervention over 2-3 weeks. Outcomes will be assessed at baseline (T0), immediately post treatment (T1), and 6 weeks after end of treatment (T2), and at comparable timepoints for participants in the waitlist control group. Feasibility will be evaluated by assessing recruitment/retention rates and blinding success. Acceptability will be assessed quantitatively via participant ratings and qualitatively via semi-structured interviews. Episodes of binge eating at follow-up will be the primary clinical outcome and rate ratios from Poisson regression will be reported. Secondary outcomes will assess changes in ED and general psychopathology, attention bias toward high calorie foods, and executive function. DISCUSSION It is hoped that data from the trial will contribute to the development of neurobiologically informed treatments for BED, provide insights into the potential use of at-home variants of tDCS, and inform the design of future large scale trials.
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Affiliation(s)
- Michaela Flynn
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Iain Campbell
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Wang J, Luo H, Schülke R, Geng X, Sahakian BJ, Wang S. Is transcranial direct current stimulation, alone or in combination with antidepressant medications or psychotherapies, effective in treating major depressive disorder? A systematic review and meta-analysis. BMC Med 2021; 19:319. [PMID: 34915885 PMCID: PMC8680114 DOI: 10.1186/s12916-021-02181-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/08/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) has shown mixed results for depression treatment. The efficacies of tDCS combination therapies have not been investigated deliberately. This review aims to evaluate the clinical efficacy of tDCS as a monotherapy and in combination with medication, psychotherapy, and ECT for treating adult patients with major depressive disorder (MDD) and identified the factors influencing treatment outcome measures (i.e. depression score, dropout, response, and remission rates). METHODS The systematic review was performed in PubMed/Medline, EMBASE, PsycINFO, Web of Sciences, and OpenGrey. Two authors performed independent literature screening and data extraction. The primary outcomes were the standardized mean difference (SMD) for continuous depression scores after treatment and odds ratio (OR) dropout rate; secondary outcomes included ORs for response and remission rates. Random effects models with 95% confidence intervals were employed in all outcomes. The overall effect of tDCS was investigated by meta-analysis. Sources of heterogeneity were explored via subgroup analyses, meta-regression, sensitivity analyses, and assessment of publication bias. RESULTS Twelve randomised, sham-controlled trials (active group: N = 251, sham group: N = 204) were included. Overall, the integrated depression score of the active group after treatment was significantly lower than that of the sham group (g = - 0.442, p = 0.017), and further analysis showed that only tDCS + medication achieved a significant lower score (g = - 0.855, p < 0.001). Moreover, this combination achieved a significantly higher response rate than sham intervention (OR = 2.7, p = 0.006), while the response rate remained unchanged for the other three therapies. Dropout and remission rates were similar in the active and sham groups for each therapy and also for the overall intervention. The meta-regression results showed that current intensity is the only predictor for the response rate. None of publication bias was identified. CONCLUSION The effect size of tDCS treatment was obviously larger in depression score compared with sham stimulation. The tDCS combined selective serotonin re-uptake inhibitors is the optimized therapy that is effective on depression score and response rate. tDCS monotherapy and combined psychotherapy have no significant effects. The most important parameter for optimization in future trials is treatment strategy.
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Affiliation(s)
- Jingying Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China.,Shanghai Engineering Research Center of AI & Robotics, Fudan University, Shanghai, China.,Engineering Research Center of AI & Robotics, Ministry of Education, Fudan University, Shanghai, China
| | - Huichun Luo
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rasmus Schülke
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Xinyi Geng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China.,Shanghai Engineering Research Center of AI & Robotics, Fudan University, Shanghai, China.,Engineering Research Center of AI & Robotics, Ministry of Education, Fudan University, Shanghai, China
| | - Barbara J Sahakian
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433, China.,Department of Psychiatry, University of Cambridge, Cambridge, UK.,Behavioural Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Shouyan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433, China. .,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China. .,Shanghai Engineering Research Center of AI & Robotics, Fudan University, Shanghai, China. .,Engineering Research Center of AI & Robotics, Ministry of Education, Fudan University, Shanghai, China.
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Cinosi E, Adam D, Aslan I, Baldwin D, Chillingsworth K, Enara A, Gale T, Garg K, Garner M, Gordon R, Hall N, Huneke NTM, Kucukterzi-Ali S, McCarthy J, Meron D, Monji-Patel D, Mooney R, Robbins T, Smith M, Sireau N, Wellsted D, Wyatt S, Fineberg NA. Feasibility and acceptability of transcranial stimulation in obsessive-compulsive symptoms (FEATSOCS): study protocol for a randomised controlled trial of transcranial direct current stimulation (tDCS) in obsessive-compulsive disorder (OCD). Pilot Feasibility Stud 2021; 7:213. [PMID: 34872621 PMCID: PMC8646008 DOI: 10.1186/s40814-021-00945-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder which often proves refractory to current treatment approaches. Transcranial direct current stimulation (tDCS), a noninvasive form of neurostimulation, with potential for development as a self-administered intervention, has shown potential as a safe and efficacious treatment for OCD in a small number of trials. The two most promising stimulation sites are located above the orbitofrontal cortex (OFC) and the supplementary motor area (SMA). METHODS The aim of this feasibility study is to inform the development of a definitive trial, focussing on the acceptability, safety of the intervention, feasibility of recruitment, adherence and tolerability to tDCS and study assessments and the size of the treatment effect. To this end, we will deliver a double-blind, sham-controlled, crossover randomised multicentre study in 25 adults with OCD. Each participant will receive three courses of tDCS (SMA, OFC and sham), randomly allocated and given in counterbalanced order. Each course comprises four 20-min stimulations, delivered over two consecutive days, separated by at least 4 weeks' washout period. We will collect information about recruitment, study conduct and tDCS delivery. Blinded raters will assess clinical outcomes before, during and up to 4 weeks after stimulation using validated scales. We will include relevant objective neurocognitive tasks, testing cognitive flexibility, motor disinhibition, cooperation and habit learning. DISCUSSION We will analyse the magnitude of the effect of the interventions on OCD symptoms alongside the standard deviation of the outcome measure, to estimate effect size and determine the optimal stimulation target. We will also measure the duration of the effect of stimulation, to provide information on spacing treatments efficiently. We will evaluate the usefulness and limitations of specific neurocognitive tests to determine a definitive test battery. Additionally, qualitative data will be collected from participants to better understand their experience of taking part in a tDCS intervention, as well as the impact on their overall quality of life. These clinical outcomes will enable the project team to further refine the methodology to ensure optimal efficiency in terms of both delivering and assessing the treatment in a full-scale trial. TRIAL REGISTRATION ISRCTN17937049 . (date applied 08/07/2019). Recruitment (ongoing) began 23rd July 2019 and is anticipated to complete 30th April 2021.
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Affiliation(s)
- Eduardo Cinosi
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK.
- University of Hertfordshire, Hertfordshire, UK.
| | - David Adam
- ORCHARD-Advancing Global OCD Research Charity, Cambridge, UK
| | - Ibrahim Aslan
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
| | - David Baldwin
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
| | - Kieran Chillingsworth
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
| | - Arun Enara
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
| | - Tim Gale
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
- University of Hertfordshire, Hertfordshire, UK
| | - Kabir Garg
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
| | - Matthew Garner
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
| | - Robert Gordon
- Southern Health NHS Foundation Trust, Southampton, UK
| | | | - Nathan T M Huneke
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Sonay Kucukterzi-Ali
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
- University of Hertfordshire, Hertfordshire, UK
| | | | - Daniel Meron
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
- Somerset NHS Foundation Trust, Taunton, UK
| | - Deela Monji-Patel
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
- University of Hertfordshire, Hertfordshire, UK
| | | | - Trevor Robbins
- Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Megan Smith
- University of Hertfordshire, Hertfordshire, UK
| | - Nick Sireau
- ORCHARD-Advancing Global OCD Research Charity, Cambridge, UK
| | | | | | - Naomi A Fineberg
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
- University of Hertfordshire, Hertfordshire, UK
- Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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34
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Xia Y, Li Y, Khalid W, Bikson M, Fu BM. Direct Current Stimulation Disrupts Endothelial Glycocalyx and Tight Junctions of the Blood-Brain Barrier in vitro. Front Cell Dev Biol 2021; 9:731028. [PMID: 34650977 PMCID: PMC8505730 DOI: 10.3389/fcell.2021.731028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/08/2021] [Indexed: 01/01/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive physical therapy to treat many psychiatric disorders and to enhance memory and cognition in healthy individuals. Our recent studies showed that tDCS with the proper dosage and duration can transiently enhance the permeability (P) of the blood-brain barrier (BBB) in rat brain to various sized solutes. Based on the in vivo permeability data, a transport model for the paracellular pathway of the BBB also predicted that tDCS can transiently disrupt the endothelial glycocalyx (EG) and the tight junction between endothelial cells. To confirm these predictions and to investigate the structural mechanisms by which tDCS modulates P of the BBB, we directly quantified the EG and tight junctions of in vitro BBB models after DCS treatment. Human cerebral microvascular endothelial cells (hCMECs) and mouse brain microvascular endothelial cells (bEnd3) were cultured on the Transwell filter with 3 μm pores to generate in vitro BBBs. After confluence, 0.1–1 mA/cm2 DCS was applied for 5 and 10 min. TEER and P to dextran-70k of the in vitro BBB were measured, HS (heparan sulfate) and hyaluronic acid (HA) of EG was immuno-stained and quantified, as well as the tight junction ZO-1. We found disrupted EG and ZO-1 when P to dextran-70k was increased and TEER was decreased by the DCS. To further investigate the cellular signaling mechanism of DCS on the BBB permeability, we pretreated the in vitro BBB with a nitric oxide synthase (NOS) inhibitor, L-NMMA. L-NMMA diminished the effect of DCS on the BBB permeability by protecting the EG and reinforcing tight junctions. These in vitro results conform to the in vivo observations and confirm the model prediction that DCS can disrupt the EG and tight junction of the BBB. Nevertheless, the in vivo effects of DCS are transient which backup its safety in the clinical application. In conclusion, our current study directly elucidates the structural and signaling mechanisms by which DCS modulates the BBB permeability.
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Affiliation(s)
- Yifan Xia
- Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, United States
| | - Yunfei Li
- Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, United States
| | - Wasem Khalid
- Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, United States
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, United States
| | - Bingmei M Fu
- Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, United States
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Herrera-Melendez AL, Bajbouj M, Aust S. Application of Transcranial Direct Current Stimulation in Psychiatry. Neuropsychobiology 2021; 79:372-383. [PMID: 31340213 DOI: 10.1159/000501227] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a neuromodulation technique, which noninvasively alters cortical excitability via weak polarizing currents between two electrodes placed on the scalp. Since it is comparably easy to handle, cheap to use and relatively well tolerated, tDCS has gained increasing interest in recent years. Based on well-known behavioral effects, a number of clinical studies have been performed in populations including patients with major depressive disorder followed by schizophrenia and substance use disorders, in sum with heterogeneous results with respect to efficacy. Nevertheless, the potential of tDCS must not be underestimated since it could be further improved by systematically investigating the various stimulation parameters to eventually increase clinical efficacy. The present article briefly explains the underlying physiology of tDCS, summarizes typical stimulation protocols and then reviews clinical efficacy for various psychiatric disorders as well as prevalent adverse effects. Future developments include combined and more complex interactions of tDCS with pharmacological or psychotherapeutic interventions. In particular, using computational models to individualize stimulation protocols, considering state dependency and applying closed-loop technologies will pave the way for tDCS-based personalized interventions as well as the development of home treatment settings promoting the role of tDCS as an effective treatment option for patients with mental health problems.
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Affiliation(s)
- Ana-Lucia Herrera-Melendez
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany,
| | - Malek Bajbouj
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sabine Aust
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Rubia K, Westwood S, Aggensteiner PM, Brandeis D. Neurotherapeutics for Attention Deficit/Hyperactivity Disorder (ADHD): A Review. Cells 2021; 10:2156. [PMID: 34440925 PMCID: PMC8394071 DOI: 10.3390/cells10082156] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/07/2021] [Accepted: 08/18/2021] [Indexed: 01/19/2023] Open
Abstract
This review focuses on the evidence for neurotherapeutics for attention deficit/hyperactivity disorder (ADHD). EEG-neurofeedback has been tested for about 45 years, with the latest meta-analyses of randomised controlled trials (RCT) showing small/medium effects compared to non-active controls only. Three small studies piloted neurofeedback of frontal activations in ADHD using functional magnetic resonance imaging or near-infrared spectroscopy, finding no superior effects over control conditions. Brain stimulation has been applied to ADHD using mostly repetitive transcranial magnetic and direct current stimulation (rTMS/tDCS). rTMS has shown mostly negative findings on improving cognition or symptoms. Meta-analyses of tDCS studies targeting mostly the dorsolateral prefrontal cortex show small effects on cognitive improvements with only two out of three studies showing clinical improvements. Trigeminal nerve stimulation has been shown to improve ADHD symptoms with medium effect in one RCT. Modern neurotherapeutics are attractive due to their relative safety and potential neuroplastic effects. However, they need to be thoroughly tested for clinical and cognitive efficacy across settings and beyond core symptoms and for their potential for individualised treatment.
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Affiliation(s)
- Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London SE5 8AF, UK;
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London SE5 8AF, UK
- Department of Child & Adolescent Psychiatry, Transcampus, Dresden University, 01307 Dresden, Germany
| | - Samuel Westwood
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London SE5 8AF, UK;
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London SE5 8AF, UK
- Department of Psychology, Wolverhampton University, Wolverhampton WV1 1LY, UK
| | - Pascal-M. Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 68159 Mannheim, Germany; (P.-M.A.); (D.B.)
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 68159 Mannheim, Germany; (P.-M.A.); (D.B.)
- Department of Child and Adolescent Psychiatry and Psychotherapy, Hospital of Psychiatry, Psychiatric Hospital University, University of Zürich, 8032 Zürich, Switzerland
- Neuroscience Center Zürich, Swiss Federal Institute of Technology and University of Zürich, 8057 Zürich, Switzerland
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Amthor FR, Strang CE. Effects of tACS-Like Electrical Stimulation on On-Center Retinal Ganglion Cells: Part I. Eye Brain 2021; 13:175-192. [PMID: 34285622 PMCID: PMC8285569 DOI: 10.2147/eb.s312402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/11/2021] [Indexed: 01/30/2023] Open
Abstract
Purpose Electrical stimulation of the human central nervous system via surface electrodes has been used for both learning enhancement and the amelioration of neurodegenerative or psychiatric disorders. However, data are sparse on how such electrical stimulation affects neural circuits at the cellular level. This study assessed the effects of tACS-like currents at 10 Hz on On-center retinal ganglion cell responsiveness, using the rabbit retina eyecup preparation as a model for central nervous system effects. Methods We made extracellular recordings of light-evoked spike responses in different classes of On-center retinal ganglion cells before, during and after brief applications of 1 microampere alternating currents using single electrodes and microelectrode arrays. Results tACS-like currents (tACS) of 1 microampere produced effects on On-center ganglion cell response profiles immediately after initiation or cessation of tACS, without driving phase-locked firing in the absence of light stimuli. tACS affected the initial transient responses to light stimulation for all cells, sustained response components (if any) more strongly for sustained cells, and the center-surround balance more strongly for transient cells. Conclusion tACS sculpted light-evoked responses that lasted for one or more hours after cessation of current without, itself, directly inducing significant firing changes. Functionally, tACS effects could result in effects on contrast thresholds for both broad classes of cells, but because tACs differentially affects the center-surround balance of transient On-center cells, there may be greater effects on the spatial resolution and gain. The isolated retina appears to be a useful model to understand tACS actions at the neuronal level.
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Affiliation(s)
- Franklin R Amthor
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, 35294-1170, USA
| | - Christianne E Strang
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, 35294-1170, USA
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Grycuk L, Moruzzi F, Bardjesteh E, Gaughran F, Campbell IC, Schmidt U. Participant Experiences of Transcranial Direct Current Stimulation (tDCS) as a Treatment for Antipsychotic Medication Induced Weight Gain. Front Psychol 2021; 12:694203. [PMID: 34234727 PMCID: PMC8255922 DOI: 10.3389/fpsyg.2021.694203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite the growing number of studies on the use of non-invasive brain stimulation in people with schizophrenia, there is limited research on participant views of such treatment methods. Aim: Explore participant experiences and perceptions of transcranial direct current stimulation (tDCS). Methods: Twelve people with schizophrenia took part in semi-structured interviews after having completed 5 sessions of tDCS. Thematic analysis was used to identify codes and themes. Results: Five themes were identified: (1) motivation for study enrolment; (2) concerns about tDCS; (3) factors reducing the fear of tDCS; (4) experience of tDCS; (5) perceived effects of tDCS. Conclusions: The study provides insight into the perceptions and experiences of each individual. Participants were concerned about the safety of tDCS and associated it with invasive procedures such as electroconvulsive therapy and lobotomy. Educational materials and a good relationship with the researcher played an important role in reducing the fear of brain stimulation. All participants described tDCS as uncomfortable, however, agreed that unpleasant sensations only lasted for a short while (20 s-5 min). After the first session, participants no longer felt anxious about the remaining ones. Strategies to improve treatment experience and study recruitment have been identified.
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Affiliation(s)
- Luiza Grycuk
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Francesca Moruzzi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Elena Bardjesteh
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom
| | - Iain C. Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom
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Wu L, Liu T, Wang J. Improving the Effect of Transcranial Alternating Current Stimulation (tACS): A Systematic Review. Front Hum Neurosci 2021; 15:652393. [PMID: 34163340 PMCID: PMC8215166 DOI: 10.3389/fnhum.2021.652393] [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: 01/12/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022] Open
Abstract
With the development of electrical stimulation technology, traditional transcranial alternating current stimulation (tACS) technology has been found to have the drawback of not targeting a specific area accurately. Studies have shown that optimizing the number and position of electrodes during electrical stimulation has a very good effect on enhancing brain stimulation accuracy. At present, an increasing number of laboratories have begun to optimize tACS. However, there has been no study summarizing the optimization methods of tACS. Determining whether different optimization methods are effective and the optimization approach could provide information that could guide future tACS research. We describe the results of recent research on tACS optimization and integrate the optimization approaches of tACS in recent research. Optimization approaches can be classified into two groups: high-definition electrical stimulation and interference modulation electrical stimulation. The optimization methods can be divided into five categories: high-definition tACS, phase-shifted tACS, amplitude-modulated tACS, the temporally interfering (TI) method, and the intersectional short pulse (ISP) method. Finally, we summarize the latest research on hardware useful for tACS improvement and outline future directions.
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Affiliation(s)
- Linyan Wu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China.,National Engineering Research Center of Health Care and Medical Devices, Guangzhou, China.,The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi'an, China
| | - Tian Liu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China.,National Engineering Research Center of Health Care and Medical Devices, Guangzhou, China.,The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi'an, China
| | - Jue Wang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China.,National Engineering Research Center of Health Care and Medical Devices, Guangzhou, China.,The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi'an, China
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Pereira HC, Sousa D, Simões M, Martins R, Amaral C, Lopes V, Crisóstomo J, Castelo-Branco M. Effects of anodal multichannel transcranial direct current stimulation (tDCS) on social-cognitive performance in healthy subjects: A randomized sham-controlled crossover pilot study. PROGRESS IN BRAIN RESEARCH 2021; 264:259-286. [PMID: 34167659 DOI: 10.1016/bs.pbr.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Recent studies suggest that temporoparietal junction (TPJ) modulation can influence attention and social cognition performance. Nevertheless, no studies have used multichannel transcranial direct current stimulation (tDCS) over bilateral TPJ to estimate the effects on these neuropsychological functions. The project STIPED is using optimized multichannel stimulation as an innovative treatment approach for chronic pediatric neurodevelopmental disorders, namely in children/adolescents with Autism Spectrum Disorder (ASD). In this pilot study, we aim to explore whether anodal multichannel tDCS coupled with a Joint Attention Task (JAT) influences social-cognitive task performance relative to sham stimulation, both in an Emotion Recognition Task (ERT) and in a Mooney Faces Detection Task (MFDT), as well as to evaluate this technique's safety and tolerability. Twenty healthy adults were enrolled in a randomized, single-blinded, sham-controlled, crossover study. During two sessions, participants completed the ERT and the MFDT before and after 20min of sham or anodal tDCS over bilateral TPJ. No significant differences on performance accuracy and reaction time were found between stimulation conditions for all tasks, including the JAT. A significant main time effect for overall accuracy and reaction time was found for the MFDT. Itching was the most common side effect and stimulation conditions detection was at chance level. Results suggest that multichannel tDCS over bilateral TPJ does not affect performance of low-level emotional recognition tasks in healthy adults. Although preliminary safety and tolerability are demonstrated, further studies over longer periods will be pursued to investigate the clinical efficacy in children/adolescents with ASD, where social cognition impairments are preponderant.
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Affiliation(s)
- H Catarina Pereira
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal; Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Daniela Sousa
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal; Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - Marco Simões
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal; Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Centre for Informatics and Systems, University of Coimbra, Coimbra, Portugal
| | - Ricardo Martins
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal; Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - Carlos Amaral
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal; Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Vânia Lopes
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal; Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - Joana Crisóstomo
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal; Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal; Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
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Brauer H, Breitling-Ziegler C, Moliadze V, Galling B, Prehn-Kristensen A. Transcranial direct current stimulation in attention-deficit/hyperactivity disorder: A meta-analysis of clinical efficacy outcomes. PROGRESS IN BRAIN RESEARCH 2021; 264:91-116. [PMID: 34167666 DOI: 10.1016/bs.pbr.2021.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence for the application of transcranial direct current stimulation (tDCS) in the clinical care of attention-deficit/hyperactivity disorder (ADHD) is limited. Therefore, we aimed to summarize study results using meta-analyses of measures of the cardinal symptoms of ADHD. METHODS We conducted a systematic literature search (PubMed/pubpsych/PsychInfo/WOS) until 01/05/2020 for randomized controlled trials (RCTs) evaluating tDCS vs. control condition in patients with ADHD. A random effects meta-analysis of symptom-related outcomes was performed separately for data on the immediate effect and follow-up. Subgroup- and metaregression analyses for patient characteristics and tDCS parameters were included. RESULTS Meta-analyzing 13 studies (n=308, age=23.7±13.3), including 20 study arms, tDCS had an immediate effect on overall symptom severity, inattention, and impulsivity, but not on hyperactivity. Results were significant in children and adolescents (8 studies, n=133, age=12.4±3.0). Follow-up data (3 days-4 weeks after stimulation) suggested an ongoing beneficial effect regarding overall symptom severity and a delayed effect on hyperactivity. DISCUSSION TDCS seems to be a promising method to treat clinical symptoms in ADHD with long-lasting effects. Still, more research considering the individual neuropsychological and anatomical dispositions of the subjects is needed to optimize tDCS protocols and efficacy. Safety issues of tDCS treatment in children and adolescents are addressed.
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Affiliation(s)
- Hannah Brauer
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, School of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany.
| | - Carolin Breitling-Ziegler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Vera Moliadze
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel, Germany
| | - Britta Galling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, School of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany; Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Child and Adolescent Psychosomatic Medicine and Psychotherapy, Altona Children's Hospital, Hamburg, Germany
| | - Alexander Prehn-Kristensen
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, School of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
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Lopes BC, Medeiros LF, Stein DJ, Cioato SG, de Souza VS, Medeiros HR, Sanches PRS, Fregni F, Caumo W, Torres ILS. tDCS and exercise improve anxiety-like behavior and locomotion in chronic pain rats via modulation of neurotrophins and inflammatory mediators. Behav Brain Res 2021; 404:113173. [PMID: 33577881 DOI: 10.1016/j.bbr.2021.113173] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Abstract
Anxiety disorders cause distress and are commonly found to be comorbid with chronic pain. Both are difficult-to-treat conditions for which alternative treatment options are being pursued. This study aimed to evaluate the effects of transcranial direct current stimulation (tDCS), treadmill exercise, or both, on anxiety-like behavior and associated growth factors and inflammatory markers in the hippocampus and sciatic nerve of rats with neuropathic pain. Male Wistar rats (n = 216) were subjected to sham-surgery or sciatic nerve constriction for pain induction. Fourteen days following neuropathic pain establishment, either bimodal tDCS, treadmill exercise, or a combination of both was used for 20 min a day for 8 consecutive days. The elevated plus-maze test was used to assess anxiety-like behavior and locomotor activity during the early (24 h) or late (7 days) phase after the end of treatment. BDNF, TNF-ɑ, and IL-10 levels in the hippocampus, and BDNF, NGF, and IL-10 levels in the sciatic nerve were assessed 48 h or 7 days after the end of treatment. Rats from the pain groups developed an anxiety-like state. Both tDCS and treadmill exercise provided ethological and neurochemical alterations induced by pain in the early and/or late phase, and a modest synergic effect between tDCS and exercise was observed. These results indicate that non-invasive neuromodulatory approaches can attenuate both anxiety-like status and locomotor activity and alter the biochemical profile in the hippocampus and sciatic nerve of rats with neuropathic pain and that combined interventions may be considered as a treatment option.
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Affiliation(s)
- Bettega Costa Lopes
- Laboratório de Farmacologia da Dor e Neuromodulação: Investigações Pré-Clínicas, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, 90035-007 Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Instituto de Ciências Básicas da Saúde, (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), 90050-170 Porto Alegre, Brazil
| | - Liciane Fernandes Medeiros
- Laboratório de Farmacologia da Dor e Neuromodulação: Investigações Pré-Clínicas, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, 90035-007 Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Farmacologia e Terapêutica, Universidade Federal Rio Grande do Sul, 90050-170 Porto Alegre, Brazil; Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Universidade La Salle, 92010-000 Canoas, Brazil.
| | - Dirson João Stein
- Laboratório de Farmacologia da Dor e Neuromodulação: Investigações Pré-Clínicas, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, 90035-007 Porto Alegre, Brazil; Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, 90035-003 Porto Alegre, Brazil
| | - Stefania Giotti Cioato
- Laboratório de Farmacologia da Dor e Neuromodulação: Investigações Pré-Clínicas, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, 90035-007 Porto Alegre, Brazil
| | - Vanessa Silva de Souza
- Laboratório de Farmacologia da Dor e Neuromodulação: Investigações Pré-Clínicas, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, 90035-007 Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Farmacologia e Terapêutica, Universidade Federal Rio Grande do Sul, 90050-170 Porto Alegre, Brazil
| | - Helouise Richardt Medeiros
- Laboratório de Farmacologia da Dor e Neuromodulação: Investigações Pré-Clínicas, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, 90035-007 Porto Alegre, Brazil; Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, 90035-003 Porto Alegre, Brazil
| | - Paulo Roberto Stefani Sanches
- Laboratório de Engenharia Biomédica, Grupo de Pesquisa e Pós-Graduação, Hospital de Clínicas de Porto Alegre, 90035-003 Porto Alegre, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital & Massachusetts General Hospital. Harvard Medical School and Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, 02215 Boston, USA
| | - Wolnei Caumo
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, 90035-003 Porto Alegre, Brazil
| | - Iraci L S Torres
- Laboratório de Farmacologia da Dor e Neuromodulação: Investigações Pré-Clínicas, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, 90035-007 Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Instituto de Ciências Básicas da Saúde, (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), 90050-170 Porto Alegre, Brazil; Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, 90035-003 Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Farmacologia e Terapêutica, Universidade Federal Rio Grande do Sul, 90050-170 Porto Alegre, Brazil.
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Gupta T, Mittal VA. Transcranial direct current stimulation and emotion processing deficits in psychosis and depression. Eur Arch Psychiatry Clin Neurosci 2021; 271:69-84. [PMID: 32488523 PMCID: PMC7704557 DOI: 10.1007/s00406-020-01146-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/23/2020] [Indexed: 01/11/2023]
Abstract
Emotional processing deficits (EPDs) are commonly observed among individuals diagnosed with (1) psychotic disorders (2) and depression. Given that EPDs can impact overall functioning and quality of life, the need to identify effective interventions is critical. To date, our current understanding of treatments for these impairments is limited. However, there is increasing interest in investigating the efficacy of transcranial direct current stimulation (tDCS). This neuromodulation technique releases a weak electrical current through the brain. Given research suggesting promise for using tDCS to improve symptoms and cognition across psychopathology, this approach may be useful for improving EPDs and related symptoms in psychosis and depression. In the current review, we provide an overview of the literature determining the effects of tDCS for EPDs and related symptoms in these groups. Furthermore, we highlight methodological advances and pinpoint potential future directions.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL, 60208, USA.
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL, 60208, USA
- Department of Psychiatry, Northwestern University, Chicago, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
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Colella M, Paffi A, De Santis V, Apollonio F, Liberti M. Effect of skin conductivity on the electric field induced by transcranial stimulation techniques in different head models. Phys Med Biol 2021; 66:035010. [PMID: 33496268 DOI: 10.1088/1361-6560/abcde7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study aims at quantifying the effect that using different skin conductivity values has on the estimation of the electric (E)-field distribution induced by transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in the brain of two anatomical models. The induced E-field was calculated with numerical simulations inside MIDA and Duke models, assigning to the skin a conductivity value estimated from a multi-layered skin model and three values taken from literature. The effect of skin conductivity variations on the local E-field induced by tDCS in the brain was up to 70%. In TMS, minor local differences, in the order of 20%, were obtained in regions of interest for the onset of possible side effects. Results suggested that an accurate model of the skin is necessary in all numerical studies that aim at precisely estimating the E-field induced during TMS and tDCS applications. This also highlights the importance of further experimental studies on human skin characterization, especially at low frequencies.
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Affiliation(s)
- Micol Colella
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome 'La Sapienza', Rome, Italy
| | - Alessandra Paffi
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome 'La Sapienza', Rome, Italy
| | - Valerio De Santis
- Department of Industrial and Information Engineering and Economics (DIIEE), University of L'Aquila, L'Aquila, Italy
| | - Francesca Apollonio
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome 'La Sapienza', Rome, Italy
| | - Micaela Liberti
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome 'La Sapienza', Rome, Italy
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Westwood SJ, Radua J, Rubia K. Noninvasive brain stimulation in children and adults with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. J Psychiatry Neurosci 2021; 46:E14-E33. [PMID: 33009906 PMCID: PMC7955851 DOI: 10.1503/jpn.190179] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) could provide treatment alternatives to stimulant medication for attention-deficit/hyperactivity disorder (ADHD), given some evidence for improvements in cognition and clinical symptoms. However, despite a lack of solid evidence for their use, rTMS and tDCS are already offered clinically and commercially in ADHD. This systematic review and meta-analysis aimed to critically appraise rTMS and tDCS studies in ADHD to inform good research and clinical practice. METHODS A systematic search (up to February 2019) identified 18 studies (rTMS 4, tDCS 14; 311 children and adults with ADHD) stimulating mainly the dorsolateral prefrontal cortex (dlPFC). We included 12 anodal tDCS studies (232 children and adults with ADHD) in 3 random-effects meta-analyses of cognitive measures of attention, inhibition and processing speed. RESULTS The review of rTMS and tDCS showed positive effects in some functions but not others, and little evidence for clinical improvement. The meta-analyses of 1 to 5 sessions of anodal tDCS over mainly the left or bilateral dlPFC showed trend-level improvements in inhibition and processing speed, but not in attention. LIMITATIONS Heterogeneity in stimulation parameters, patient age and outcome measures limited the interpretation of findings. CONCLUSION The review and meta-analysis showed limited evidence that 1 to 5 sessions of rTMS and tDCS, mostly of the dlPFC, improved clinical or cognitive measures of ADHD. These findings did not support using rTMS or tDCS of the dlPFC as an alternative neurotherapy for ADHD as yet. Larger, multi-session stimulation studies identifying more optimal sites and stimulation parameters in combination with cognitive training could achieve larger effects.
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Affiliation(s)
- Samuel J Westwood
- From the Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom (Westwood, Rubia); the Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain (Radua); the Mental Health Research Networking Centre (CIBERSAM), Madrid, Spain (Radua); the Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, Sweden (Radua); and the Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, United Kingdom (Radua)
| | - Joaquim Radua
- From the Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom (Westwood, Rubia); the Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain (Radua); the Mental Health Research Networking Centre (CIBERSAM), Madrid, Spain (Radua); the Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, Sweden (Radua); and the Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, United Kingdom (Radua)
| | - Katya Rubia
- From the Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom (Westwood, Rubia); the Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain (Radua); the Mental Health Research Networking Centre (CIBERSAM), Madrid, Spain (Radua); the Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, Sweden (Radua); and the Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, United Kingdom (Radua)
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Jeong H, Oh JK, Choi EK, Im JJ, Yoon S, Knotkova H, Bikson M, Song IU, Lee SH, Chung YA. Effects of transcranial direct current stimulation on addictive behavior and brain glucose metabolism in problematic online gamers. J Behav Addict 2020; 9:1011-1021. [PMID: 33361487 PMCID: PMC8969730 DOI: 10.1556/2006.2020.00092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/11/2020] [Accepted: 10/30/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIMS Some online gamers may encounter difficulties in controlling their gaming behavior. Previous studies have demonstrated beneficial effects of transcranial direct current stimulation (tDCS) on various kinds of addiction. This study investigated the effects of tDCS on addictive behavior and regional cerebral metabolic rate of glucose (rCMRglu) in problematic online gamers. METHODS Problematic online gamers were randomized and received 12 sessions of either active (n = 13) or sham tDCS (n = 13) to the dorsolateral prefrontal cortex over 4 weeks (anode F3/cathode F4, 2 mA for 30 min, 3 sessions per week). Participants underwent brain 18F-fluoro-2-deoxyglucose positron emission tomography scans and completed questionnaires including the Internet Addiction Test (IAT), Brief Self-Control Scale (BSCS), and Behavioral Inhibition System/Behavioral Activation System scales (BIS/BAS) at the baseline and 4-week follow-up. RESULTS Significant decreases in time spent on gaming (P = 0.005), BIS (P = 0.03), BAS-fun seeking (P = 0.04), and BAS-reward responsiveness (P = 0.01), and increases in BSCS (P = 0.03) were found in the active tDCS group, while decreases in IAT were shown in both groups (P < 0.001). Group-by-time interaction effects were not significant for these measures. Increases in BSCS scores were correlated with decreases in IAT scores in the active group (β = -0.85, P < 0.001). rCMRglu in the left putamen, pallidum, and insula was increased in the active group compared to the sham group (P for interaction < 0.001). DISCUSSION AND CONCLUSIONS tDCS may be beneficial for problematic online gaming potentially through changes in self-control, motivation, and striatal/insular metabolism. Further larger studies with longer follow-up period are warranted to confirm our findings.
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Affiliation(s)
- Hyeonseok Jeong
- Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea,Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jin Kyoung Oh
- Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Eun Kyoung Choi
- Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jooyeon Jamie Im
- Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sujung Yoon
- Department of Brain and Cognitive Sciences and Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA,Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - In-Uk Song
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang Hoon Lee
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea,Corresponding author.
| | - Yong-An Chung
- Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea,Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea,Corresponding author.
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47
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Green PE, Loftus A, Anderson RA. Protocol for Transcranial Direct Current Stimulation for Obsessive-Compulsive Disorder. Brain Sci 2020; 10:brainsci10121008. [PMID: 33352970 PMCID: PMC7765941 DOI: 10.3390/brainsci10121008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a debilitating disorder with an approximate lifetime prevalence of 1–3%. Despite advances in leading treatment modalities, including pharmacotherapy and psychotherapy, some cases remain treatment resistant. Non-invasive brain stimulation has been explored in this treatment-resistant population with some promising findings; however, a lack of methodological rigor has reduced the quality of the findings. The current paper presents the protocol for conducting research into the efficacy of transcranial direct current stimulation (tDCS) in the treatment of OCD. A double-blind randomised controlled trial (RCT) will be conducted involving active tDCS vs. sham tDCS on 40 general OCD patients. The intervention consists of 2 mA anodal stimulation over the pre-supplementary motor area (pre-SMA) with the cathode positioned over the orbitofrontal cortex (OFC). Participants will receive 10 sessions of 20 min of either sham- or active-tDCS over 4 weeks. Outcomes will be categorical and dimensional measures of OCD, as well as related secondary clinical measures (depression, anxiety, quality of life), and neurocognitive functions (inhibitory control, cognitive flexibility).
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Buhagiar F, Fitzgerald M, Bell J, Allanson F, Pestell C. Neuromodulation for Mild Traumatic Brain Injury Rehabilitation: A Systematic Review. Front Hum Neurosci 2020; 14:598208. [PMID: 33362494 PMCID: PMC7759622 DOI: 10.3389/fnhum.2020.598208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/20/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Mild traumatic brain injury (mTBI) results from an external force to the head or body causing neurophysiological changes within the brain. The number and severity of symptoms can vary, with some individuals experiencing rapid recovery, and others having persistent symptoms for months to years, impacting their quality of life. Current rehabilitation is limited in its ability to treat persistent symptoms and novel approaches are being sought to improve outcomes following mTBI. Neuromodulation is one technique used to encourage adaptive neuroplasticity within the brain. Objective: To systematically review the literature on the efficacy of neuromodulation in the mTBI population. Method: A systematic review was conducted using Medline, Embase, PsycINFO, PsycARTICLES and EBM Review. Preferred Reporting Items for Systematic Reviews and the Synthesis Without Meta-analysis reporting guidelines were used and a narrative review of the selected studies was completed. Fourteen articles fulfilled the inclusion criteria which were published in English, investigating an adult sample and using a pre- and post-intervention design. Studies were excluded if they included non-mild TBI severities, pediatric or older adult populations. Results: Thirteen of fourteen studies reported positive reductions in mTBI symptomatology following neuromodulation. Specifically, improvements were reported in post-concussion symptom ratings, headaches, dizziness, depression, anxiety, sleep disturbance, general disability, cognition, return to work and quality of life. Normalization of working memory activation patterns, vestibular field potentials, hemodynamics of the dorsolateral prefrontal cortex and excessive delta wave activity were also seen. The studies reviewed had several methodological limitations including small, heterogenous samples and varied intervention protocols, limiting generalisability. Further research is required to understand the context in which neuromodulation may be beneficial. Conclusions: While these positive effects are observed, limitations included unequal representation of neuromodulation modalities in the literature, and lack of literature describing the efficacy of neuromodulation on the development or duration of persistent mTBI symptoms. Better clarity regarding neuromodulation efficacy could have a significant impact on mTBI patients, researchers, clinicians, and policy makers, facilitating a more productive post-mTBI population. Despite the limitations, the literature indicates that neuromodulation warrants further investigation. PROSPERO registration number: CRD42020161279.
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Affiliation(s)
- Francesca Buhagiar
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Sarich Neuroscience Research Institute, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, Nedlands, WA, Australia
| | - Jason Bell
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Fiona Allanson
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Carmela Pestell
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
- Curtin University, Perth, WA, Australia
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Fang G, Wang Y. Transcranial direct current stimulation (tDCS) produce anti-anxiety response in acute stress exposure rats via activation of amygdala CB1R. Behav Brain Res 2020; 400:113050. [PMID: 33279640 DOI: 10.1016/j.bbr.2020.113050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Abstract
Anxiety is one of the most common mental disorders worldwide. Currently, the main anti-anxiety drugs, selective serotonin/noradrenalin reuptake inhibitors (SSRIs/SNRIs), are always associated with delayed onset of action and low therapeutic response rate. Benzodiazepines can produce rapid effects, but their long-term use may result in severe adverse reaction and drug dependence. Transcranial direct current stimulation (tDCS) is one of the noteworthy noninvasive brain stimulation techniques and is expected to be a new choice of anti-anxiety therapy. However, the underlying mechanism remains unclear. In our recent published study, we have observed the important role of endogenous cannabinoid in the pathophysiology and treatment of anxiety. Here we verified the anti-anxiety effects of tDCS in the acute stress exposure rats, and investigated the possible role of amygdala cannabinoid receptor 1 (CB1R) activation in the anti-anxiety response of tDCS. Forced swimming exposure produced anxiety-like behaviors, which can be reversed by tDCS treatment. tDCS increased the time spent in the center without affection of locomotor activity in open field test (OFT) and elevated the number of entries into open arm and time spent in open arm in elevated plus maze test (EPMT). However, Inhibition of CB1R function by AM251 intraperitoneal injection or CB1R knockdown in amygdala produced the negative effects on the anti-anxiety action of tDCS. In conclusion, tDCS may play an anti-anxiety role at least partly via activation of amygdala CB1R, which provides a theoretical basis for the clinical application of tDCS in the treatment of anxiety disorder.
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Affiliation(s)
- Guoxiang Fang
- Department of Emergency, Xi'an No.3 Hospital, the Affiliated Hospital of Northwest University, Xi'an, Shaanxi, 710018, PR China
| | - Ying Wang
- Department of Psychiatry, Xi'an International Medical Center Hospital, the Affiliated Hospital of Northwest University, Xi'an, Shaanxi, 710100, China.
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Mehrsafar AH, Rosa MAS, Zadeh AM, Gazerani P. A feasibility study of application and potential effects of a single session transcranial direct current stimulation (tDCS) on competitive anxiety, mood state, salivary levels of cortisol and alpha amylase in elite athletes under a real-world competition. Physiol Behav 2020; 227:113173. [DOI: 10.1016/j.physbeh.2020.113173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/15/2020] [Accepted: 09/04/2020] [Indexed: 01/29/2023]
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