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Hu R, Li J, Lu Y, Luo H, Zhang Y, Wang X, Zhang Z, Luo Q. The effect of transcranial direct current stimulation (tDCS) on cognitive function recovery in patients with depression following electroconvulsive therapy (ECT): protocol for a randomized controlled trial. BMC Psychiatry 2024; 24:130. [PMID: 38365634 PMCID: PMC10870564 DOI: 10.1186/s12888-024-05567-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/29/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a highly effective treatment for depressive disorder. However, the use of ECT is limited by its cognitive side effects (CSEs), and no specific intervention has been developed to address this problem. As transcranial direct current stimulation (tDCS) is a safe and useful tool for improving cognitive function, the main objective of this study was to explore the ability to use tDCS after ECT to ameliorate the cognitive side effects. METHODS 60 eligible participants will be recruited within two days after completing ECT course and randomly assigned to receive either active or sham stimulation in a blinded, parallel-design trial and continue their usual pharmacotherapy. The tDCS protocol consists of 30-min sessions at 2 mA, 5 times per week for 2 consecutive weeks, applied through 15-cm2 electrodes. An anode will be placed over the left dorsolateral prefrontal cortex (DLPFC), and a cathode will be placed over the right supraorbital cortex. Cognitive function and depressive symptoms will be assessed before the first stimulation (T0), after the final stimulation (T1), 2 weeks after the final stimulation (T2), and 4 weeks after the final stimulation (T3) using the Cambridge Neuropsychological Test Automated Battery (CANTAB). DISCUSSION We describe a novel clinical trial to explore whether the administration of tDCS after completing ECT course can accelerates recovery from the CSEs. We hypothesized that the active group would recover faster from the CSEs and be superior to the sham group. If our hypothesis is supported, the use of tDCS could benefit eligible patients who are reluctant to receive ECT and reduce the risk of self-inflicted or suicide due to delays in treatment. TRIAL REGISTRATION DETAILS The trial protocol is registered with https://www.chictr.org.cn/ under protocol registration number ChiCTR2300071147 (date of registration: 05.06.2023). Recruitment will start in November 2023.
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Affiliation(s)
- Renqin Hu
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Junyao Li
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yulin Lu
- Department of Psychiatry, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Huirong Luo
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yinlin Zhang
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xueqian Wang
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zheng Zhang
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qinghua Luo
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Chmiel J, Rybakowski F, Leszek J. Effect of Transcranial Direct Current Stimulation (tDCS) on Depression in Parkinson's Disease-A Narrative Review. J Clin Med 2024; 13:699. [PMID: 38337395 PMCID: PMC10856764 DOI: 10.3390/jcm13030699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Depression is the most prevalent comorbid neuropsychiatric condition in individuals with Parkinson's disease (PD), and its underlying mechanisms are not yet fully understood. Current treatment methods are characterised by moderate effectiveness and possible side effects, prompting the search for new non-invasive and safe treatment methods. METHODS This narrative review explores the use of transcranial direct current stimulation (tDCS) in the treatment of depression in PD, based on neuropsychological measures. Searches were conducted in the PubMed/Medline, Research Gate, and Cochrane databases. RESULTS Nine relevant studies were identified, where depression scores served as either primary or secondary outcomes. Stimulation protocols displayed heterogeneity, especially concerning choice of stimulation site. Patient samples were also heterogeneous. The majority of the studies incorporated anodal stimulation targeting the left dorsolateral prefrontal cortex (DLPFC). The results revealed a reduction in depression scores among PD patients following tDCS. Potential mechanisms through which tDCS may alleviate depression in PD were discussed and recommendations for future research were made. CONCLUSIONS Preliminary evidence suggests that tDCS applied anodally to the left DLPFC reduces depression scores in people with PD; however, due to the heterogeneity of the studies analysed, the use of tDCS in this field should be approached with caution and warrants further validation and confirmation.
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Affiliation(s)
- James Chmiel
- Institute of Neurofeedback and tDCS Poland, 70-393 Szczecin, Poland
| | - Filip Rybakowski
- Department and Clinic of Psychiatry, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Jerzy Leszek
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
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Chmiel J, Gladka A, Leszek J. The Effect of Transcranial Direct Current Stimulation (tDCS) on Anorexia Nervosa: A Narrative Review. Nutrients 2023; 15:4455. [PMID: 37892530 PMCID: PMC10610104 DOI: 10.3390/nu15204455] [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: 09/18/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Introduction: Anorexia nervosa (AN) is a severe, debilitating disease with high incidence and high mortality. The methods of treatment used so far are moderately effective. Evidence from neuroimaging studies helps to design modern methods of therapy. One of them is transcranial direct current stimulation (tDCS), a non-invasive brain neuromodulation technique. (2) Methods: The purpose of this narrative review is to bring together all studies investigating the use of tDCS in the treatment of AN and to evaluate its effect and efficiency. Searches were conducted in the Pubmed/Medline, Research Gate, and Cochrane databases. (3) Results: The literature search resulted in five articles. These studies provide preliminary evidence that tDCS has the potential to alter eating behaviour, body weight, and food intake. Additionally, tDCS reduced symptoms of depression. Throughout all trials, stimulation targeted the left dorsolateral prefrontal cortex (DLPFC). Although the number of studies included is limited, attempts were made to elucidate the potential mechanisms underlying tDCS action in individuals with AN. Recommendations for future tDCS research in AN were issued. (4) Conclusions: The included studies have shown that tDCS stimulation of the left DLPFC has a positive effect on AN clinical symptoms and may improve them, as measured by various assessment measures. It is important to conduct more in-depth research on the potential benefits of using tDCS for treating AN. This should entail well-designed studies incorporating advanced neuroimaging techniques, such as fMRI. The aim is to gain a better understanding of how tDCS works in AN.
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Affiliation(s)
- James Chmiel
- Institute of Neurofeedback and tDCS Poland, 70-393 Szczecin, Poland
| | - Anna Gladka
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
| | - Jerzy Leszek
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
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Zanao TA, Luethi MS, Goerigk S, Suen P, Diaz AP, Soares JC, Brunoni AR. White matter predicts tDCS antidepressant effects in a sham-controlled clinical trial study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1421-1431. [PMID: 36336757 DOI: 10.1007/s00406-022-01504-7] [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: 04/26/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been used as treatment for depression, but its effects are heterogeneous. We investigated, in a subsample of the clinical trial Escitalopram versus Electrical Direct Current Therapy for Depression Study (ELECTTDCS), whether white matter areas associated with depression disorder were associated with tDCS response. Baseline diffusion tensor imaging data were analyzed from 49 patients (34 females, mean age 41.9) randomized to escitalopram 20 mg/day, tDCS (2 mA, 30 min, 22 sessions), or placebo. Antidepressant outcomes were assessed by Hamilton Depression Rating Scale-17 (HDRS) after 10-week treatment. We used whole-brain tractography for extracting white matter measures for anterior corpus callosum, and bilaterally for cingulum bundle, striato-frontal, inferior occipito-frontal fasciculus and uncinate. For the rostral body, tDCS group showed higher MD associated with antidepressant effects (estimate = -5.13 ± 1.64, p = 0.002), and tDCS significantly differed from the placebo and the escitalopram group. The left striato-frontal tract showed higher FA associated with antidepressant effects (estimate = -2.14 ± 0.72, p = 0.003), and tDCS differed only from the placebo group. For the right uncinate, the tDCS group lower AD values were associated with higher HDRS decrease (estimate = -1.45 ± 0.67, p = 0.031). Abnormalities in white matter MDD-related areas are associated with tDCS antidepressant effects. Suggested better white matter microstructure of the left prefrontal cortex was associated with tDCS antidepressant effects. Future studies should investigate whether these findings are driven by electric field diffusion and density in these areas.
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Affiliation(s)
- Tamires A Zanao
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Matthias S Luethi
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Stephan Goerigk
- Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, Laboratory of Neurosciences LIM-27), São Paulo, Brazil
- Department of Psychological Methodology and Assessment, LMU Munich, Munich, Germany
| | - Paulo Suen
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre P Diaz
- Hochschule Fresenius, University of Applied Sciences, Munich, Germany
| | - Jair C Soares
- Hochschule Fresenius, University of Applied Sciences, Munich, Germany
| | - Andre R Brunoni
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
- Hospital Universitário, Departamento de Clínica Médica, Faculdade de Medicina da USP, São Paulo, Brazil.
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Rodrigues A, Martins L, Villela NR, Razza L, Brunoni AR. Brain stimulation for treatment-resistant depression. PROGRESS IN BRAIN RESEARCH 2023; 281:55-67. [PMID: 37806716 DOI: 10.1016/bs.pbr.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Depression is one of the main public health problems in the world, having a high prevalence and being considered the main cause of disability. An important portion of patients does not respond to treatment with the initial trial of conventional antidepressants in the current depressive episode of moderate to severe intensity, which characterizes treatment-resistant depression. In this context, non-invasive neuromodulation procedures use an electric current or magnetic field to modulate the central nervous system, and they represent a new option for patients with treatment-resistant depression.
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Affiliation(s)
| | - Lisiane Martins
- University of São Paulo, Faculty of Medicine, São Paulo, Brazil
| | - Nivaldo Ribeiro Villela
- University of São Paulo, Faculty of Medicine, São Paulo, Brazil; Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Laís Razza
- University of São Paulo, Faculty of Medicine, São Paulo, Brazil; University of Ghent, Ghent, Belgium
| | - Andre R Brunoni
- University of São Paulo, Faculty of Medicine, São Paulo, Brazil; Service of Interdisciplinary Neuromodulation (SIN), Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil.
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Dumontoy S, Ramadan B, Risold PY, Pedron S, Houdayer C, Etiévant A, Cabeza L, Haffen E, Peterschmitt Y, Van Waes V. Repeated Anodal Transcranial Direct Current Stimulation (RA-tDCS) over the Left Frontal Lobe Increases Bilateral Hippocampal Cell Proliferation in Young Adult but Not Middle-Aged Female Mice. Int J Mol Sci 2023; 24:ijms24108750. [PMID: 37240095 DOI: 10.3390/ijms24108750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/28/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
Repeated anodal transcranial direct current stimulation (RA-tDCS) is a neuromodulatory technique consisting of stimulating the cerebral cortex with a weak electric anodal current in a non-invasive manner. RA-tDCS over the dorsolateral prefrontal cortex has antidepressant-like properties and improves memory both in humans and laboratory animals. However, the mechanisms of action of RA-tDCS remain poorly understood. Since adult hippocampal neurogenesis is thought to be involved in the pathophysiology of depression and memory functioning, the purpose of this work was to evaluate the impact of RA-tDCS on hippocampal neurogenesis levels in mice. RA-tDCS was applied for 20 min per day for five consecutive days over the left frontal cortex of young adult (2-month-old, high basal level of neurogenesis) and middle-aged (10-month-old, low basal level of neurogenesis) female mice. Mice received three intraperitoneal injections of bromodeoxyuridine (BrdU) on the final day of RA-tDCS. The brains were collected either 1 day or 3 weeks after the BrdU injections to quantify cell proliferation and cell survival, respectively. RA-tDCS increased hippocampal cell proliferation in young adult female mice, preferentially (but not exclusively) in the dorsal part of the dentate gyrus. However, the number of cells that survived after 3 weeks was the same in both the Sham and the tDCS groups. This was due to a lower survival rate in the tDCS group, which suppressed the beneficial effects of tDCS on cell proliferation. No modulation of cell proliferation or survival was observed in middle-aged animals. Our RA-tDCS protocol may, therefore, influence the behavior of naïve female mice, as we previously described, but its effect on the hippocampus is only transient in young adult animals. Future studies using animal models for depression in male and female mice should provide further insights into RA-tDCS detailed age- and sex-dependent effects on hippocampal neurogenesis.
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Affiliation(s)
- Stéphanie Dumontoy
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, Université de Franche-Comté, F-25000 Besançon, France
| | - Bahrie Ramadan
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, Université de Franche-Comté, F-25000 Besançon, France
| | - Pierre-Yves Risold
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, Université de Franche-Comté, F-25000 Besançon, France
| | | | - Christophe Houdayer
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, Université de Franche-Comté, F-25000 Besançon, France
| | - Adeline Etiévant
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, Université de Franche-Comté, F-25000 Besançon, France
| | - Lidia Cabeza
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, Université de Franche-Comté, F-25000 Besançon, France
| | - Emmanuel Haffen
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, Université de Franche-Comté, F-25000 Besançon, France
| | - Yvan Peterschmitt
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, Université de Franche-Comté, F-25000 Besançon, France
| | - Vincent Van Waes
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, Université de Franche-Comté, F-25000 Besançon, France
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Luo L, You W, DelBello MP, Gong Q, Li F. Recent advances in psychoradiology. Phys Med Biol 2022; 67. [PMID: 36279868 DOI: 10.1088/1361-6560/ac9d1e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/24/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Psychiatry, as a field, lacks objective markers for diagnosis, progression, treatment planning, and prognosis, in part due to difficulties studying the brain in vivo, and diagnoses are based on self-reported symptoms and observation of patient behavior and cognition. Rapid advances in brain imaging techniques allow clinical investigators to noninvasively quantify brain features at the structural, functional, and molecular levels. Psychoradiology is an emerging discipline at the intersection of psychiatry and radiology. Psychoradiology applies medical imaging technologies to psychiatry and promises not only to improve insight into structural and functional brain abnormalities in patients with psychiatric disorders but also to have potential clinical utility. We searched for representative studies related to recent advances in psychoradiology through May 1, 2022, and conducted a selective review of 165 references, including 75 research articles. We summarize the novel dynamic imaging processing methods to model brain networks and present imaging genetics studies that reveal the relationship between various neuroimaging endophenotypes and genetic markers in psychiatric disorders. Furthermore, we survey recent advances in psychoradiology, with a focus on future psychiatric diagnostic approaches with dimensional analysis and a shift from group-level to individualized analysis. Finally, we examine the application of machine learning in psychoradiology studies and the potential of a novel option for brain stimulation treatment based on psychoradiological findings in precision medicine. Here, we provide a summary of recent advances in psychoradiology research, and we hope this review will help guide the practice of psychoradiology in the scientific and clinical fields.
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Park TY, Jeong JH, Chung YA, Yeo SH, Kim H. Application of subject-specific helmets for the study of human visuomotor behavior using transcranial focused ultrasound: a pilot study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107127. [PMID: 36126434 DOI: 10.1016/j.cmpb.2022.107127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/27/2022] [Accepted: 09/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE As a novel non-invasive human brain stimulation method, transcranial focused ultrasound (tFUS) is receiving growing attention due to its superior spatial specificity and depth penetrability. Since the focal point of tFUS needs to be fixated precisely to the target brain region during stimulation, a critical issue is to identify and maintain the accurate position and orientation of the tFUS transducer relative to the subject's head. This study aims to propose the entire framework of tFUS stimulation integrating the methods previously proposed by the authors for tFUS transducer configuration optimization and a subject-specific 3D-printed helmet, and to validate this complete setup in a human behavioral neuromodulation study. METHODS To find the optimal configuration of the tFUS transducer, a numerical method based on subject-specific tFUS beamlines simulation was used. Then, the subject-specific 3D-printed helmet has been applied to effectively secure the transducer at the estimated optimal configuration. To validate this tFUS framework, a common behavioral neuromodulation paradigm was chosen; the effect of the dorsolateral prefrontal cortex (DLPFC) stimulation on anti-saccade (AS) behavior. While human participants (n=2) were performing AS tasks, tFUS stimulations were randomly applied to the left DLPFC right after the fixation target disappeared. RESULTS The neuromodulation result strongly suggests that the cortical stimulation using the proposed tFUS setup is effective in significantly reducing the error rates of anti-saccades (about -10 %p for S1 and -16 %p for S2), whereas no significant effect was observed on their latencies. These observed behavioral effects are consistent with the previous results based on conventional brain stimulation or lesion studies. CONCLUSIONS The proposed subject-specific tFUS framework has been effectively used in human neuromodulation study. The result suggests that the tFUS stimulation targeted to the DLPFC can generate a neuromodulatory effect on AS behavior.
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Affiliation(s)
- Tae Young Park
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea; Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology, Seoul, 02792, Republic of Korea
| | - Ji Hyeok Jeong
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea; Department of Brain and Cognitive Engineering, Korea University, Seoul, 136-713, Republic of Korea
| | - Yong An Chung
- Incheon St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Sang Hoon Yeo
- School of Sport, Exercise & Rehabilitation Sciences, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
| | - Hyungmin Kim
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea; Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology, Seoul, 02792, Republic of Korea.
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Paneva J, Leunissen I, Schuhmann T, de Graaf TA, Jønsson MG, Onarheim B, Sack AT. Using Remotely Supervised At-Home TES for Enhancing Mental Resilience. Front Hum Neurosci 2022; 16:838187. [PMID: 35754763 PMCID: PMC9218567 DOI: 10.3389/fnhum.2022.838187] [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: 12/17/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
We are in the midst of a mental health crisis with major depressive disorder being the most prevalent among mental health disorders and up to 30% of patients not responding to first-line treatments. Noninvasive Brain Stimulation (NIBS) techniques have proven to be effective in treating depression. However, there is a fundamental problem of scale. Currently, any type of NIBS treatment requires patients to repeatedly visit a clinic to receive brain stimulation by trained personnel. This is an often-insurmountable barrier to both patients and healthcare providers in terms of time and cost. In this perspective, we assess to what extent Transcranial Electrical Stimulation (TES) might be administered with remote supervision in order to address this scaling problem and enable neuroenhancement of mental resilience at home. Social, ethical, and technical challenges relating to hardware- and software-based solutions are discussed alongside the risks of stimulation under- or over-use. Solutions to provide users with a safe and transparent ongoing assessment of aptitude, tolerability, compliance, and/or misuse are proposed, including standardized training, eligibility screening, as well as compliance and side effects monitoring. Looking into the future, such neuroenhancement could be linked to prevention systems which combine home-use TES with digital sensor and mental monitoring technology to index decline in mental wellbeing and avoid relapse. Despite the described social, ethical legal, and technical challenges, the combination of remotely supervised, at-home TES setups with dedicated artificial intelligence systems could be a powerful weapon to combat the mental health crisis by bringing personalized medicine into people’s homes.
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Affiliation(s)
- Jasmina Paneva
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht, Netherlands
| | - Inge Leunissen
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht, Netherlands
| | - Teresa Schuhmann
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht, Netherlands.,Centre for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands
| | - Tom A de Graaf
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht, Netherlands.,Centre for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands
| | - Morten Gørtz Jønsson
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht, Netherlands
| | | | - Alexander T Sack
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht, Netherlands.,Centre for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Brain + Nerve Centre, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
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Ceccanti M, Cambieri C, Libonati L, Tartaglia G, Moret F, Garibaldi M, Inghilleri M. Effects of Skin Stimulation on Sensory-Motor Networks Excitability: Possible Implications for Physical Training in Amyotrophic Lateral Sclerosis. Front Neurol 2022; 13:868792. [PMID: 35693021 PMCID: PMC9174685 DOI: 10.3389/fneur.2022.868792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMany different trials were assessed for rehabilitation of patients with amyotrophic lateral sclerosis (ALS), with non-unique results. Beside the effects on muscle trophism, some of the encouraging results of physical training could be ascribed to the modulation of cortical excitability, which was found hyperexcited in ALS.ObjectiveThe effects of tactile skin stimulation in the modulation of the sensory-motor integrative networks in healthy subjects were assayed through the paired associative stimulation (PAS) protocol.MethodsIn total, 15 healthy subjects were enrolled. In the standard PAS session, the average amplitude of the motor evoked potential (MEP) after 10 stimuli of transcranial magnetic stimulation (TMS) was measured at the baseline and after the PAS protocol (0, 10, 20, 30, and 60 min). In the skin stimulation session, the average amplitude of the MEP was measured before and after 10 min of skin stimulation over the hand. Subsequently, each subject underwent the PAS stimulation and the measure of the average amplitude of the MEP (0, 10, 20, 30, and 60 min).ResultsThe tactile skin stimulation on healthy subjects increases the PAS-induced sensory-motor network hyperexcitability in healthy subjects.ConclusionSkin stimulation should be avoided in the physiotherapeutic approaches for patients with ALS, given the possible hyperexciting effects on the already upmodulated sensory-motor networks. They can be taken into account for diseases characterized by downregulation of cortical and transcortical networks.
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Affiliation(s)
- Marco Ceccanti
- Department of Human Neuroscience, Center for Rare Neuromuscular Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
- *Correspondence: Marco Ceccanti
| | - Chiara Cambieri
- Department of Human Neuroscience, Center for Rare Neuromuscular Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Laura Libonati
- Department of Human Neuroscience, Center for Rare Neuromuscular Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giorgio Tartaglia
- Department of Human Neuroscience, Center for Rare Neuromuscular Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federica Moret
- Department of Human Neuroscience, Center for Rare Neuromuscular Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Matteo Garibaldi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Neuromuscular and Rare Disease Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maurizio Inghilleri
- Department of Human Neuroscience, Center for Rare Neuromuscular Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Labree B, Hoare DJ, Gascoyne LE, Scutt P, Del Giovane C, Sereda M. Determining the Effects of Transcranial Direct Current Stimulation on Tinnitus, Depression, and Anxiety: A Systematic Review. Brain Sci 2022; 12:brainsci12040484. [PMID: 35448015 PMCID: PMC9029345 DOI: 10.3390/brainsci12040484] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Tinnitus is the awareness of a sound in the absence of an external source. It affects around 10–15% of people, a significant proportion of whom also experience symptoms such as depression or anxiety that negatively affect their quality of life. Transcranial direct current stimulation (tDCS) is a technique involving constant low-intensity direct current delivered via scalp electrodes. It is a potential treatment option for tinnitus, as well as tinnitus-related conditions such as depression and anxiety. This systematic review estimates the effects of tDCS on outcomes relevant to tinnitus. In addition, it sheds light on the relationship between stimulation parameters and the effect of tDCS on these outcomes; (2) Methods: Exhaustive searches of electronic databases were conducted. Randomised controlled trials were included if they reported at least one of the following outcomes: tinnitus symptom severity, anxiety, or depression. Where available, data on quality of life, adverse effects, and neurophysiological changes were also reviewed. GRADE was used to assess the certainty in the estimate; (3) Results: Meta-analyses revealed a statistically significant reduction in tinnitus (moderate certainty) and depression (low certainty)-but not anxiety-following active tDCS compared to sham control. Network meta-analyses revealed potential optimal stimulation parameters; (4) Conclusions: The evidence synthesised in this review suggests tDCS has the potential to reduce symptom severity in tinnitus and depression. It further narrows down the number of potentially optimal stimulation parameters.
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Affiliation(s)
- Bas Labree
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; (D.J.H.); (P.S.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Correspondence:
| | - Derek J. Hoare
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; (D.J.H.); (P.S.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Lauren E. Gascoyne
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2XQ, UK;
| | - Polly Scutt
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; (D.J.H.); (P.S.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Cinzia Del Giovane
- Department of Medical and Surgical Sciences for Children and Adults, University-Hospital of Modena and Reggio Emilia, 41124 Modena, Italy;
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; (D.J.H.); (P.S.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
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Oh J, Jang KI, Jeon S, Chae JH. Effect of Self-administered Transcranial Direct Stimulation in Patients with Major Depressive Disorder: A Randomized, Single-blinded Clinical Trial. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2022; 20:87-96. [PMID: 35078951 PMCID: PMC8813309 DOI: 10.9758/cpn.2022.20.1.87] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/27/2020] [Accepted: 12/31/2020] [Indexed: 11/18/2022]
Abstract
Objective In numerous studies that have addressed transcranial direct current stimulation (tDCS) devices, participants visit the hospital regularly and undergo stimulation directed by health professionals. This method has the advantage of being able to deliver accurate stimuli in a controlled environment, but it does not adopt the merits of tDCS portability and applicability. Thus, it may be necessary to investigate how self-administered tDCS treatment at home affects depression-related symptoms. Methods In this randomized, single-blinded clinical trial, 58 patients with major depressive disorder were assigned to active and sham tDCS stimulation groups, and treatment responses were evaluated biweekly over six weeks. Both active and sham tDCS treatment group were treated with escitalopram. All participants were instructed the protocol and usage of at-home tDCS device, and self-administered tDCS treatment at their home. Results The beck-depression inventory score decreased significantly as treatment progressed, and the degree of symptom improvement was significantly higher in the active group than in the sham tDCS group. There were no significant differences between the two groups in other indices, including the Hamilton Depression Scale. Conclusion These results suggest that patient-administered tDCS treatment might be effective in improving subjective symptoms of depression.
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Affiliation(s)
- Jihoon Oh
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kuk-In Jang
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sekye Jeon
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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13
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Gonsalvez I, Spagnolo P, Dworetzky B, Baslet G. Neurostimulation for the treatment of functional neurological disorder: A systematic review. Epilepsy Behav Rep 2021; 16:100501. [PMID: 34950864 PMCID: PMC8671519 DOI: 10.1016/j.ebr.2021.100501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 01/02/2023] Open
Abstract
Functional Neurological Disorder (FND), also known as conversion disorder, is characterized by neurological symptoms that are incompatible with any known structural disorder and best explained by a biopsychosocial model. Evidence-based treatments for FND are limited, with cognitive behavioral therapy (CBT) and physiotherapy being the most effective interventions [1]. In recent years, functional neuroimaging studies have provided robust evidence of alterations in activity and connectivity in multiple brain networks in FND. This body of evidence suggests that neurocircuitry-based interventions, such as non-invasive brain stimulation techniques (NIBS), may also represent an effective therapeutic option for patients with FND. In this systematic review, we outline the current state of knowledge of NIBS in FND, and discuss limitations and future directions that may help establish the efficacy of NIBS as a therapeutic option for FND.
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Affiliation(s)
- Irene Gonsalvez
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Primavera Spagnolo
- Mary Horrigan Connors Center for Women's Health & Gender Biology, Department of Psychiatry, Brigham and Women Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Barbara Dworetzky
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Toth AJ, Ramsbottom N, Constantin C, Milliet A, Campbell MJ. The effect of expertise, training and neurostimulation on sensory-motor skill in esports. COMPUTERS IN HUMAN BEHAVIOR 2021. [DOI: 10.1016/j.chb.2021.106782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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15
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Singh S, Meena AK, Sharma G, Deshpande SN. A pilot study on effect of adjunctive transcranial direct current stimulation on symptom domains of depression in patients with depressive disorder. Ind Psychiatry J 2021; 30:305-309. [PMID: 35017816 PMCID: PMC8709522 DOI: 10.4103/ipj.ipj_38_20] [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: 03/30/2020] [Revised: 04/11/2021] [Accepted: 08/09/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Depression is a highly prevalent condition and includes clusters of symptoms, namely, depressive cognition, anxiety, and visceral symptoms. Depressive symptoms often respond sub-optimally to pharmacotherapy. Adjunctive transcranial direct current stimulation (tDCS), a noninvasive brain stimulation modality, may improve depressive symptomatology. AIM The aim of this study was to study the effect of tDCS as an augmentation strategy in depression and its various symptom domains. MATERIALS AND METHODS It is a prospective interventional study. Patients diagnosed with depressive disorder (based on International Classification of Disease- 10 criteria, diagnosed by treating psychiatrist), aged 18-70 years, who showed inadequate improvement on antidepressant selective serotonin reuptake inhibitors, were recruited after informed consent. Each participant was administered 20 sessions of tDCS over 2 weeks, each session of 20 min, with anode placement at left dorsolateral prefrontal cortex and cathode at right supraorbital region. Hamilton Rating Scale for Depression (HAM-D) was administered pre- and post-intervention to assess the change in symptoms. RESULTS Of a total of 35 participants, the mean score on HAM-D prior to and postintervention was 19.97 (standard deviation [SD] = 3.519) and 13.17 (SD = 3.365), respectively. The difference was statistically highly significant (P = 0.000) on paired t-test. All symptom domains of HAM-D, identified using the Cole and Motivala model (Cole et al., 2004), also showed significant reduction from pre-tDCS to post-tDCS scores (P = 0.000). CONCLUSION Positive effect of tDCS on depressive symptoms, its tolerability and safety profile, and affordability makes it an effective therapeutic strategy in augmenting antidepressants in patients with depression. However, longer period studies with larger sample size may yield more generalizable results.
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Affiliation(s)
- Shipra Singh
- Department of Psychiatry, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Amit K Meena
- Department of Psychiatry, G.B. Pant Hospital, Delhi, India
| | - Gautam Sharma
- Department of Psychiatry, ABVIMS, Dr. R.M.L. Hospital, Delhi, India
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Chen T, Wang H, Wang X, Zhu C, Zhang L, Wang K, Yu F. Transcranial direct current stimulation of the right dorsolateral prefrontal cortex improves response inhibition. Int J Psychophysiol 2021. [DOI: 10.1016/j.ijpsycho.2021.01.014
expr 874926689 + 897791409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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17
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Labree B, Hoare DJ, Gascoyne LE, Sereda M. Determining the effects of transcranial direct current stimulation on tinnitus and tinnitus-related outcomes: protocol for a systematic review. BMJ Open 2021; 11:e047191. [PMID: 33771831 PMCID: PMC8006855 DOI: 10.1136/bmjopen-2020-047191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Tinnitus is the awareness of a sound in the ear or head in the absence of an external source. It affects around 10%-15% of people. About 20% of people with tinnitus also experience symptoms such as depression or anxiety that negatively affect their life. Transcranial direct current stimulation (tDCS) is a technique involving constant low-intensity direct current delivered via electrodes on the head. It is postulated to modulate (suppress or enhance) neural activity in the region between electrodes. As such, it represents a potential treatment option for tinnitus, as well as comorbid depression or anxiety. This systematic review will estimate the effects of tDCS on outcomes relevant to tinnitus. In addition, it will determine whether there is any relationship between stimulation parameters (electrode montage, current intensity, and length and frequency of stimulation sessions) and the effect of tDCS on these outcomes. METHODS AND ANALYSIS Electronic searches for peer-reviewed journal articles will be performed in the Cochrane Register of Studies online (the Cochrane Ear, Nose and Throat Disorders Group Register and CENTRAL, current issue), PubMed, EMBASE, CINAHL, LILACS, KoreaMed, IndMed, PakMediNet, CNKI, AMED, PsycINFO, Web of Science, ClinicalTrials.gov, ICTRP and Google Scholar using the following search terms: transcranial Direct Current Stimulation OR tDCS AND tinnitus OR depression OR anxiety OR quality of life OR adverse effects OR neurophys*.Searches were not limited by date. Methods are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Randomised controlled trials will be included if they report at least one of the following outcomes: tinnitus symptom severity, anxiety or depression as measured by relevant validated instruments. Where available, data on quality of life, adverse effects and neurophysiological changes will also be reviewed. In addition to an analysis of the effect of each parameter, an analysis will be performed to uncover any interactions between parameters. Where appropriate, meta-analyses will be performed. ETHICS AND DISSEMINATION This systematic review will make use of secondary data only. As no data will be obtained from participants directly, ethical approval has not been sought. No other ethical issues are foreseen. Findings will be submitted for peer-reviewed publication and presented at academic conferences. The results of this review will inform future research. PROSPERO REGISTRATION NUMBER CRD42020185567.
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Affiliation(s)
- Bas Labree
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Hearing Sciences, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Derek J Hoare
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Hearing Sciences, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Lauren E Gascoyne
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Hearing Sciences, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
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18
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Chen T, Wang H, Wang X, Zhu C, Zhang L, Wang K, Yu F. Transcranial direct current stimulation of the right dorsolateral prefrontal cortex improves response inhibition. Int J Psychophysiol 2021; 162:34-39. [PMID: 33497765 DOI: 10.1016/j.ijpsycho.2021.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A number of functional magnetic resonance imaging studies have shown that the dorsolateral prefrontal cortex (dlPFC) is a critical brain region for response inhibition. However, how it exerts this function remains unclear. This study investigated whether stimulating the right dlPFC by transcranial direct current stimulation (tDCS) affects performance on stop signal task. METHODS A total of 92 healthy subjects were enrolled in the study and randomly divided into three groups. The anode group received anodal stimulation over the right dlPFC and cathodal stimulation over the left supraorbital; the cathode group received cathodal stimulation over the right dlPFC and anodal stimulation over the left supraorbital; and the sham group received sham tDCS. All subjects performed a computer-based stop-signal task before and after tDCS. RESULT Performance on the response inhibition task after tDCS was improved in groups with both anodal and cathodal stimulation. Specifically, there was a decrease in the stop-signal reaction time in these subjects, whereas no difference was observed in the sham group. Consistent with signal detection theory, discrimination and decision bias was improved by anode tDCS relative to the sham group, while discrimination was also improved in the cathode group. CONCLUSION Anode and cathode tDCS of the right dlPFC improves response inhibition, with the right dlPFC may playing a key role in this process.
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Affiliation(s)
- Tingting Chen
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China; Anhui Mental Health Center, Hefei, China
| | - Huihui Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Xin Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China; Anhui Mental Health Center, Hefei, China
| | - Chunyan Zhu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China; Anhui Mental Health Center, Hefei, China
| | - Lei Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China; Anhui Mental Health Center, Hefei, China
| | - Kai Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China; Anhui Mental Health Center, Hefei, China.
| | - Fengqiong Yu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China; Anhui Mental Health Center, Hefei, China.
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Hadoush H, Alqudah A, Banihani SA, Al-Jarrah M, Amro A, Aldajah S. Melatonin serum level, sleep functions, and depression level after bilateral anodal transcranial direct current stimulation in patients with Parkinson's disease: a feasibility study. Sleep Sci 2021; 14:25-30. [PMID: 34917270 PMCID: PMC8663735 DOI: 10.5935/1984-0063.20200083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/16/2020] [Indexed: 12/21/2022] Open
Abstract
Objective Parkinson's disease (PD) is associated with non-motor complications such as sleep disturbance and depression. Transcranial direct current stimulation (tDCS) showed therapeutic effects on the motor dysfunctions. However, the potential effects of tDCS therapy on melatonin hormone, sleep dysfunctions, and depression in patients with PD still unclear. This feasibility study aimed to identify any potential changes in melatonin serum level, sleep functions and depression after the bilateral anodal tDCS in patients with PD. Material and Methods Tensessions of bilateral anodal tDCS stimulation applied over left and right prefrontal and motor areas were given to twenty-five patients with PD. Melatonin serum level, Pittsburgh sleep quality index, and geriatric depression scale examined before and after tDCS stimulation. Results After bilateral anodal tDCS, there was a significant reduction in melatonin serum level, improvement in depression, improvements in overall sleep quality, and sleep latency. Correlations test showed significant associations between melatonin serum level reduction and changes in subjective sleep quality, and sleep duration, as well as between improvements in depression and overall sleep quality, sleep latency, and sleep disturbance. Conclusion Bilateral anodal tDCS therapy was a feasible and safe tool that showed potential therapeutic effects on melatonin serum level, sleep quality, and depression level in patients with PD. Although the further large scale and randomized-control trial studies are crucially needed, there is still a need for such a feasibility study to be established before such trials can be implemented as is recommended in the new medical research council guidelines.
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Affiliation(s)
- Hikmat Hadoush
- Jordan University of Science and Technology, Rehabilitation Sciences -Irbid - Irbid - Jordan
| | - Ansam Alqudah
- Jordan University of Science and Technology, Rehabilitation Sciences -Irbid - Irbid - Jordan
| | - Saleem A Banihani
- Jordan University of Science and Technology, Medical Laboratory Sciences - Irbid - Irbid - Jordan
| | - Muhammed Al-Jarrah
- Jordan University of Science and Technology, Rehabilitation Sciences -Irbid - Irbid - Jordan
| | - Akram Amro
- Al-Quds University, Physiotherapy - Jerusalem - Jerusalem - Palestinian Territories
| | - Salameh Aldajah
- Isra University, Rehabilitation Sciences -Amman - Amman - Jordan
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Effects of bifrontal transcranial direct current stimulation on brain glutamate levels and resting state connectivity: multimodal MRI data for the cathodal stimulation site. Eur Arch Psychiatry Clin Neurosci 2021; 271:111-122. [PMID: 32743758 PMCID: PMC7867555 DOI: 10.1007/s00406-020-01177-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022]
Abstract
Transcranial direct current stimulation (tDCS) over prefrontal cortex (PFC) regions is currently proposed as therapeutic intervention for major depression and other psychiatric disorders. The in-depth mechanistic understanding of this bipolar and non-focal stimulation technique is still incomplete. In a pilot study, we investigated the effects of bifrontal stimulation on brain metabolite levels and resting state connectivity under the cathode using multiparametric MRI techniques and computational tDCS modeling. Within a double-blind cross-over design, 20 subjects (12 women, 23.7 ± 2 years) were randomized to active tDCS with standard bifrontal montage with the anode over the left dorsolateral prefrontal cortex (DLPFC) and the cathode over the right DLPFC. Magnetic resonance spectroscopy (MRS) was acquired before, during, and after prefrontal tDCS to quantify glutamate (Glu), Glu + glutamine (Glx) and gamma aminobutyric acid (GABA) concentration in these areas. Resting-state functional connectivity MRI (rsfcMRI) was acquired before and after the stimulation. The individual distribution of tDCS induced electric fields (efields) within the MRS voxel was computationally modelled using SimNIBS 2.0. There were no significant changes of Glu, Glx and GABA levels across conditions but marked differences in the course of Glu levels between female and male participants were observed. Further investigation yielded a significantly stronger Glu reduction after active compared to sham stimulation in female participants, but not in male participants. For rsfcMRI neither significant changes nor correlations with MRS data were observed. Exploratory analyses of the effect of efield intensity distribution on Glu changes showed distinct effects in different efield groups. Our findings are limited by the small sample size, but correspond to previously published results of cathodal tDCS. Future studies should address gender and efield intensity as moderators of tDCS induced effects.
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Holla B, Biswal J, Ramesh V, Shivakumar V, Bharath RD, Benegal V, Venkatasubramanian G, Chand PK, Murthy P. Effect of prefrontal tDCS on resting brain fMRI graph measures in Alcohol Use Disorders: A randomized, double-blind, sham-controlled study. Prog Neuropsychopharmacol Biol Psychiatry 2020; 102:109950. [PMID: 32339664 DOI: 10.1016/j.pnpbp.2020.109950] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 03/31/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Transcranial Direct Current Stimulation (tDCS) is a promising new adjuvant approach in the treatment of Alcohol Use Disorders (AUDs) that has the potential to ameliorate the aberrations secondary to chronic alcohol use. In this study, using a randomized, double-blind, sham-controlled, parallel-arm design, we examined the effects of prefrontal tDCS on resting-state functional magnetic resonance imaging (rsfMRI) and its correlates with impulsivity and time to first lapse in subjects with AUDs. METHODS Patients with AUD as per DSM-5 criteria were randomly allocated to receive a five-day course of either verum-tDCS (n = 12) or sham-tDCS (n = 12). Of them, 21 patients (verum/sham = 11/10) participated in both baseline and post-intervention 10-min rsfMRI sessions. Outside the scanner, subjects also performed the Stop-Signal Task at two time-points (baseline and post-intervention), which provided a measure of changes in impulsivity following tDCS. After completion of the post-intervention scan, all subjects were discharged and were followed-up for 90 days post-discharge or until lapse to first alcohol use. RESULTS Graph theoretical analysis of rsfMRI data revealed that verum-tDCS (but not sham) resulted in a significant increase in the global efficiency of brain networks with a concurrent significant reduction in global clustering; network-based statistical analysis identified a significant increase in the functional connectivity of a specific sub-network involving prefrontal regions. Furthermore, increased global efficiency of brain networks following verum tDCS predicted a significantly reduced likelihood of relapse. In addition, a reduction in the global clustering had a significant positive correlation with a reduction in the measure of impulsivity. CONCLUSIONS The present study adds further support to the increasing evidence base for the clinical utility of tDCS in AUDs. Importantly, we observed improvement in both whole-brain network efficiency as well as inter-regional connectivity within a specific local prefrontal sub-network that is relevant to the neurobiology of AUDs. Replication and extension of these promising leads from the present study can facilitate clinical translation of tDCS, given its advantages (i.e. safety, cost-effectiveness, administration ease with potential for remotely-supervised / home-based application) for treating patients with AUDs.
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Affiliation(s)
- Bharath Holla
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Jitendriya Biswal
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Vinutha Ramesh
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Venkataram Shivakumar
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Rose Dawn Bharath
- Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Vivek Benegal
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Ganesan Venkatasubramanian
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
| | - Prabhat Kumar Chand
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Pratima Murthy
- Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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Adair D, Truong D, Esmaeilpour Z, Gebodh N, Borges H, Ho L, Bremner JD, Badran BW, Napadow V, Clark VP, Bikson M. Electrical stimulation of cranial nerves in cognition and disease. Brain Stimul 2020; 13:717-750. [PMID: 32289703 PMCID: PMC7196013 DOI: 10.1016/j.brs.2020.02.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 02/06/2023] Open
Abstract
The cranial nerves are the pathways through which environmental information (sensation) is directly communicated to the brain, leading to perception, and giving rise to higher cognition. Because cranial nerves determine and modulate brain function, invasive and non-invasive cranial nerve electrical stimulation methods have applications in the clinical, behavioral, and cognitive domains. Among other neuromodulation approaches such as peripheral, transcranial and deep brain stimulation, cranial nerve stimulation is unique in allowing axon pathway-specific engagement of brain circuits, including thalamo-cortical networks. In this review we amalgamate relevant knowledge of 1) cranial nerve anatomy and biophysics; 2) evidence of the modulatory effects of cranial nerves on cognition; 3) clinical and behavioral outcomes of cranial nerve stimulation; and 4) biomarkers of nerve target engagement including physiology, electroencephalography, neuroimaging, and behavioral metrics. Existing non-invasive stimulation methods cannot feasibly activate the axons of only individual cranial nerves. Even with invasive stimulation methods, selective targeting of one nerve fiber type requires nuance since each nerve is composed of functionally distinct axon-types that differentially branch and can anastomose onto other nerves. None-the-less, precisely controlling stimulation parameters can aid in affecting distinct sets of axons, thus supporting specific actions on cognition and behavior. To this end, a rubric for reproducible dose-response stimulation parameters is defined here. Given that afferent cranial nerve axons project directly to the brain, targeting structures (e.g. thalamus, cortex) that are critical nodes in higher order brain networks, potent effects on cognition are plausible. We propose an intervention design framework based on driving cranial nerve pathways in targeted brain circuits, which are in turn linked to specific higher cognitive processes. State-of-the-art current flow models that are used to explain and design cranial-nerve-activating stimulation technology require multi-scale detail that includes: gross anatomy; skull foramina and superficial tissue layers; and precise nerve morphology. Detailed simulations also predict that some non-invasive electrical or magnetic stimulation approaches that do not intend to modulate cranial nerves per se, such as transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), may also modulate activity of specific cranial nerves. Much prior cranial nerve stimulation work was conceptually limited to the production of sensory perception, with individual titration of intensity based on the level of perception and tolerability. However, disregarding sensory emulation allows consideration of temporal stimulation patterns (axon recruitment) that modulate the tone of cortical networks independent of sensory cortices, without necessarily titrating perception. For example, leveraging the role of the thalamus as a gatekeeper for information to the cerebral cortex, preventing or enhancing the passage of specific information depending on the behavioral state. We show that properly parameterized computational models at multiple scales are needed to rationally optimize neuromodulation that target sets of cranial nerves, determining which and how specific brain circuitries are modulated, which can in turn influence cognition in a designed manner.
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Affiliation(s)
- Devin Adair
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Dennis Truong
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Zeinab Esmaeilpour
- Department of Biomedical Engineering, City College of New York, New York, NY, USA.
| | - Nigel Gebodh
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Helen Borges
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Libby Ho
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - J Douglas Bremner
- Department of Psychiatry & Behavioral Sciences and Radiology, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Decatur, GA, USA
| | - Bashar W Badran
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Vitaly Napadow
- Martinos Center for Biomedical Imaging, Department of Radiology, MGH, Harvard medical school, Boston, MA, USA
| | - Vincent P Clark
- Psychology Clinical Neuroscience Center, Dept. Psychology, MSC03-2220, University of New Mexico, Albuquerque, NM, 87131, USA; Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA; The Mind Research Network of the Lovelace Biomedical Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM, 87106, USA
| | - Marom Bikson
- Department of Biomedical Engineering, City College of New York, New York, NY, USA.
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Jog M, Jann K, Yan L, Huang Y, Parra L, Narr K, Bikson M, Wang DJJ. Concurrent Imaging of Markers of Current Flow and Neurophysiological Changes During tDCS. Front Neurosci 2020; 14:374. [PMID: 32372913 PMCID: PMC7186453 DOI: 10.3389/fnins.2020.00374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/26/2020] [Indexed: 11/13/2022] Open
Abstract
Despite being a popular neuromodulation technique, clinical translation of transcranial direct current stimulation (tDCS) is hampered by variable responses observed within treatment cohorts. Addressing this challenge has been difficult due to the lack of an effective means of mapping the neuromodulatory electromagnetic fields together with the brain's response. In this study, we present a novel imaging technique that provides the capability of concurrently mapping markers of tDCS currents, as well as the brain's response to tDCS. A dual-echo echo-planar imaging (DE-EPI) sequence is used, wherein the phase of the acquired MRI-signal encodes the tDCS current induced magnetic field, while the magnitude encodes the blood oxygenation level dependent (BOLD) contrast. The proposed technique was first validated in a custom designed phantom. Subsequent test-retest experiments in human participants showed that tDCS-induced magnetic fields can be detected reliably in vivo. The concurrently acquired BOLD data revealed large-scale networks characteristic of a brain in resting-state as well as a 'cathodal' and an 'anodal' resting-state component under each electrode. Moreover, 'cathodal's BOLD-signal was observed to significantly decrease with the applied current at the group level in all datasets. With its ability to image markers of electromagnetic cause as well as neurophysiological changes, the proposed technique may provide an effective means to visualize neural engagement in tDCS at the group level. Our technique also contributes to addressing confounding factors in applying BOLD fMRI concurrently with tDCS.
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Affiliation(s)
- Mayank Jog
- Laboratory of FMRI Technology, Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States.,Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kay Jann
- Laboratory of FMRI Technology, Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
| | - Lirong Yan
- Laboratory of FMRI Technology, Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
| | - Yu Huang
- Department of Biomedical Engineering, the City College of The City University of New York, New York, NY, United States
| | - Lucas Parra
- Department of Biomedical Engineering, the City College of The City University of New York, New York, NY, United States
| | - Katherine Narr
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Marom Bikson
- Department of Biomedical Engineering, the City College of The City University of New York, New York, NY, United States
| | - Danny J J Wang
- Laboratory of FMRI Technology, Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
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Brunoni A, Ferrucci R, Bortolomasi M, Scelzo E, Boggio P, Fregni F, Dell’Osso B, Giacopuzzi M, Altamura A, Priori A. Interactions between transcranial direct current stimulation (tDCS) and pharmacological interventions in the Major Depressive Episode: Findings from a naturalistic study. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2012.09.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
AbstractBackground:Transcranial direct current stimulation (tDCS) is a non-invasive, neuromodulatory technique with an emerging role for treating major depression.Objective:To investigate the interactions between tDCS and drug therapy in unipolar and bipolar depressed patients who were refractory for at least one pharmacological treatment.Methods:This was a naturalistic study using data from 54 female and 28 male patients (mean age of 54 years) that consecutively visited our psychiatric unit. They received active tDCS (five consecutive days, 2 mA, anodal stimulation over the left and cathodal over the right dorsolateral prefrontal cortex, twice a day, 20 minutes). The outcome variable (mood) was evaluated using the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS). Predictor variables were age, gender, disorder and pharmacological treatment (seven dummy variables). We performed univariate and multivariate analyses as to identify predictors associated to the outcome.Results:After 5 days of treatment, BDI and HDRS scores decreased significantly (29% ± 36%, 18% ± 9%, respectively, P < 0.01 for both). Benzodiazepine use was independently associated with a worse outcome in both univariate (β = 4.92, P < 0.01) and multivariate (β = 5.8, P < 0.01) analyses; whereas use of dual-reuptake inhibitors positively changed tDCS effects in the multivariate model (β = –4.7, P = 0.02). A similar trend was observed for tricyclics (β = –4, P = 0.06) but not for antipsychotics, non-benzodiazepine anticonvulsants and other drugs.Conclusion:tDCS over the DLPFC acutely improved depressive symptoms. Besides the inherent limitations of our naturalistic design, our results suggest that tDCS effects might vary according to prior pharmacological treatment, notably benzodiazepines and some antidepressant classes. This issue should be further explored in controlled studies.
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Mainz V, Britz S, Forster SD, Drüke B, Gauggel S. Transcranial Direct Current Stimulation of the Medial Prefrontal Cortex Has No Specific Effect on Self-referential Processes. Front Hum Neurosci 2020; 14:56. [PMID: 32218726 PMCID: PMC7078362 DOI: 10.3389/fnhum.2020.00056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/06/2020] [Indexed: 11/13/2022] Open
Abstract
The processing of self-referential information can be influenced by transcranial magnetic stimulation (TMS). The present randomized controlled study investigated whether similar effects can be elicited through the application of transcranial direct current stimulation (tDCS) regarding the "self-serving bias" (SSB) and the "mnemic neglect effect" (MNE). Seventy-five healthy males (M age = 25; SD = 4.3) were investigated in a between-groups design with random assignment by applying anodal, cathodal, or sham tDCS to the medial prefrontal cortex (mPFC). After stimulation, the participants judged if 80 personality traits (40 positive, 40 negative) were self-descriptive or not. Finally, the participants had to recall the previously presented adjectives. All three stimulation groups showed the expected SSB and MNE. Still, and contrary to our hypotheses, tDCS revealed neither a significant interaction effect between groups and valence concerning the number of chosen self-referential traits (F (2,72) = 1.36, p = 0.26,η G 2 = 0.02) nor an interaction effect between groups, valence, and self-reference concerning the percentage of recalled words (F (2,71) = 0.69, p = 0.50,η G 2 = 0.01). However, a post hoc inspection of effect sizes revealed that less negative traits were indicated as self-referential in the anodal compared to the cathodal group (ES: -0.59; CI: -1.16 to -0.03). Moreover, the participants showed-regardless of self-reference and type of stimulation-a better recall with tDCS in comparison to sham stimulation. Our results indicate that tDCS of the mPFC in healthy young men has no influence on the SSB and the MNE. However, tDCS seems to improve memory performance.
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Affiliation(s)
- Verena Mainz
- Institute of Medical Psychology and Medical Sociology, University Hospital of the RWTH Aachen University, Aachen, Germany
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Freidle M, Nilsson J, Lebedev AV, Lövdén M. No evidence for any effect of multiple sessions of frontal transcranial direct stimulation on mood in healthy older adults. Neuropsychologia 2020; 137:107325. [PMID: 31877311 DOI: 10.1016/j.neuropsychologia.2019.107325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 12/06/2019] [Accepted: 12/20/2019] [Indexed: 11/28/2022]
Abstract
The dorsolateral prefrontal cortex (DLPFC) is part of a network important for emotional regulation and the possibility of modulating activity in this region with transcranial direct current stimulation (TDCS) to change mood has gained great interest, particularly for application in clinical populations. Whilst results in major depressive disorder have been promising, less is known about the effects of TDCS on mood in non-clinical populations. We hypothesized that multiple sessions of anodal TDCS applied over the left DLPFC would enhance mood, primarily as measured by the Profile of Mood States questionnaire, in healthy older adults. In addition, in an exploratory analysis, we examined the potentially moderating role of working memory training. Working memory, just like emotional regulation, taxes the DLPFC, which suggests that engaging in a working memory task whilst receiving TDCS may have a different effect on activity in this region and consequently mood. A total of 123 participants between 65 and 75 years of age were randomly assigned to receive either 20 sessions of TDCS, with or without working memory training, or 20 sessions sham stimulation, with or without working memory training. We found no support for enhancement of mood due to TDCS in healthy older adults, with or without cognitive training and conclude that the TDCS protocol used is unlikely to improve mood in non-depressed older individuals.
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Affiliation(s)
- Malin Freidle
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Jonna Nilsson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Alexander V Lebedev
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Lövdén
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Boayue NM, Csifcsák G, Aslaksen P, Turi Z, Antal A, Groot J, Hawkins GE, Forstmann B, Opitz A, Thielscher A, Mittner M. Increasing propensity to mind‐wander by transcranial direct current stimulation? A registered report. Eur J Neurosci 2020; 51:755-780. [DOI: 10.1111/ejn.14347] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/26/2018] [Accepted: 11/30/2018] [Indexed: 12/20/2022]
Affiliation(s)
| | - Gábor Csifcsák
- Department of PsychologyUniversity of Tromsø Tromsø Norway
| | - Per Aslaksen
- Department of PsychologyUniversity of Tromsø Tromsø Norway
| | - Zsolt Turi
- Department of Clinical NeurophysiologyUniversity Medical Center Göttingen Göttingen Germany
| | - Andrea Antal
- Department of Clinical NeurophysiologyUniversity Medical Center Göttingen Göttingen Germany
| | - Josephine Groot
- Department of PsychologyUniversity of Tromsø Tromsø Norway
- Integrative Model‐based Cognitive Neuroscience Research UnitUniversity of Amsterdam Amsterdam The Netherlands
| | - Guy E. Hawkins
- School of PsychologyUniversity of Newcastle Newcastle New South Wales Australia
| | - Birte Forstmann
- Integrative Model‐based Cognitive Neuroscience Research UnitUniversity of Amsterdam Amsterdam The Netherlands
| | - Alexander Opitz
- Department of Biomedical EngineeringUniversity of Minnesota Minneapolis MN
| | - Axel Thielscher
- Danish Research Centre for Magnetic ResonanceCentre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital Hvidovre Denmark
- Department of Electrical EngineeringTechnical University of Denmark Lyngby Denmark
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Sauvaget A, Lagalice L, Schirr-Bonnans S, Volteau C, Péré M, Dert C, Rivalland A, Tessier F, Lepage A, Tostivint A, Deschamps T, Thomas-Ollivier V, Robin A, Pineau N, Cabelguen C, Bukowski N, Guitteny M, Beslot A, Simons L, Network H, Vanelle JM, D'Urso G, Bulteau S, Riche VP. Cost-utility analysis of transcranial direct current stimulation (tDCS) in non-treatment-resistant depression: the DISCO randomised controlled study protocol. BMJ Open 2020; 10:e033376. [PMID: 31937653 PMCID: PMC7045105 DOI: 10.1136/bmjopen-2019-033376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/07/2019] [Accepted: 12/11/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Depression is among the most widespread psychiatric disorders in France. Psychiatric disorders are associated with considerable social costs, amounting to €22.6 billion for treatment and psychotropic medication in 2011. Treatment as usual (TAU), mainly consisting of pharmacotherapy and psychotherapy, is effective for only a third of patients and in most cases fails to prevent treatment resistance and chronicity. Transcranial direct current stimulation (tDCS) consists in a non-invasive and painless application of low-intensity electric current to the cerebral cortex through the scalp. Having proved effective in depressed patients, it could be used in combination with TAU to great advantage. The objective is to compare, for the first time ever, the cost-utility of tDCS-TAU and of TAU alone for the treatment of a depressive episode that has been refractory to one or two drug treatments. METHODS AND ANALYSIS This paper, based on the DISCO study protocol, focuses on the design of a prospective, randomised, controlled, open-label multicentre economic study to be conducted in France. It will include 214 patients with unipolar or bipolar depression, assigning them to two parallel arms: group A (tDCS-TAU) and group B (TAU alone). The primary outcome is the incremental cost-effectiveness ratio, that is, the ratio of the difference in cost between each strategy to the difference in their effects. Their effects will be expressed as numbers of quality-adjusted life-years, determined through administration of the EuroQol Five-Dimension questionnaire over a 12-month period to patients (EQ-5D-5L). Expected benefits are the reduction of treatment resistance and suicidal ideation as well as social and professional costs of depression. Should depression-related costs fall significantly, tDCS might be considered an efficient treatment for depression. ETHICS AND DISSEMINATION This protocol has been approved by a French ethics committee, the CPP--Est IV (Comité de Protection des Personnes-Strasbourg). Data are to be published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER RCB 2018-A00474-51; NCT03758105.
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Affiliation(s)
- Anne Sauvaget
- CHU de Nantes, Addictology and Liaison Psychiatry Department, Hospital University of Nantes, Nantes, France
- Nantes Université, CHU Nantes,Movement, Interactions, Performance (MIP), EA 4334, University of Nantes, Nantes, France
| | - Lydie Lagalice
- CHU de Nantes, Addictology and Liaison Psychiatry Department, Hospital University of Nantes, Nantes, France
| | - Solène Schirr-Bonnans
- CHU de Nantes, Innovation Cell, Partnership and Innovation Department, Directorate of Medical Affairs and Research, University Hospital Centre Nantes, Nantes, France
| | - Christelle Volteau
- CHU de Nantes, Section of Methodology and Biostatistics, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
| | - Morgane Péré
- CHU de Nantes, Section of Methodology and Biostatistics, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
| | - Cécile Dert
- CHU de Nantes, Innovation Cell, Partnership and Innovation Department, Directorate of Medical Affairs and Research, University Hospital Centre Nantes, Nantes, France
| | - Annabelle Rivalland
- CHU de Nantes, Addictology and Liaison Psychiatry Department, Hospital University of Nantes, Nantes, France
| | - Fabienne Tessier
- CHU de Nantes, Addictology and Liaison Psychiatry Department, Hospital University of Nantes, Nantes, France
| | - Adeline Lepage
- CHU de Nantes, Addictology and Liaison Psychiatry Department, Hospital University of Nantes, Nantes, France
| | - Agathe Tostivint
- CHU de Nantes, Addictology and Liaison Psychiatry Department, Hospital University of Nantes, Nantes, France
| | - Thibault Deschamps
- Nantes Université, CHU Nantes,Movement, Interactions, Performance (MIP), EA 4334, University of Nantes, Nantes, France
| | - Véronique Thomas-Ollivier
- Nantes Université, CHU Nantes,Movement, Interactions, Performance (MIP), EA 4334, University of Nantes, Nantes, France
| | - Alison Robin
- Nantes Université, CHU Nantes,Movement, Interactions, Performance (MIP), EA 4334, University of Nantes, Nantes, France
| | - Noémie Pineau
- Nantes Université, CHU Nantes,Movement, Interactions, Performance (MIP), EA 4334, University of Nantes, Nantes, France
| | - Clémence Cabelguen
- CHU de Nantes, Addictology and Liaison Psychiatry Department, Hospital University of Nantes, Nantes, France
| | - Nicolas Bukowski
- CHU de Nantes, Addictology and Liaison Psychiatry Department, Hospital University of Nantes, Nantes, France
| | - Marie Guitteny
- CHU de Nantes, Addictology and Liaison Psychiatry Department, Hospital University of Nantes, Nantes, France
| | - Auxane Beslot
- CHU de Nantes, Addictology and Liaison Psychiatry Department, Hospital University of Nantes, Nantes, France
| | - Luc Simons
- CHU de Nantes, Addictology and Liaison Psychiatry Department, Hospital University of Nantes, Nantes, France
| | | | - Jean-Marie Vanelle
- CHU de Nantes, Addictology and Liaison Psychiatry Department, Hospital University of Nantes, Nantes, France
| | - Giordano D'Urso
- Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples Federico II, Napoli, Campania, Italy
| | - Samuel Bulteau
- CHU de Nantes, Addictology and Liaison Psychiatry Department, Hospital University of Nantes, Nantes, France
- Inserm, SPHERE U1246, University of Nantes, Nantes, Pays de la Loire, France
| | - Valéry-Pierre Riche
- CHU de Nantes, Innovation Cell, Partnership and Innovation Department, Directorate of Medical Affairs and Research, University Hospital Centre Nantes, Nantes, France
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Song S, Zilverstand A, Gui W, Li HJ, Zhou X. Effects of single-session versus multi-session non-invasive brain stimulation on craving and consumption in individuals with drug addiction, eating disorders or obesity: A meta-analysis. Brain Stimul 2019; 12:606-618. [DOI: 10.1016/j.brs.2018.12.975] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 12/18/2018] [Accepted: 12/24/2018] [Indexed: 01/09/2023] Open
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Wardzinski EK, Friedrichsen L, Dannenberger S, Kistenmacher A, Melchert UH, Jauch-Chara K, Oltmanns KM. Double transcranial direct current stimulation of the brain increases cerebral energy levels and systemic glucose tolerance in men. J Neuroendocrinol 2019; 31:e12688. [PMID: 30659676 DOI: 10.1111/jne.12688] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 12/14/2018] [Accepted: 01/15/2019] [Indexed: 12/31/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a neuromodulatory method that has been tested experimentally and has already been used as an adjuvant therapeutic option to treat a number of neurological disorders and neuropsychiatric diseases. Beyond its well known local effects within the brain, tDCS also transiently promotes systemic glucose uptake and reduces the activity of the neurohormonal stress axes. We aimed to test whether the effects of a single tDCS application could be replicated upon double stimulation to persistently improve systemic glucose tolerance and stress axes activity in humans. In a single-blinded cross-over study, we examined 15 healthy male volunteers. Anodal tDCS vs sham was applied twice in series. Systemic glucose tolerance was investigated by the standard hyperinsulinaemic-euglycaemic glucose clamp procedure, and parameters of neurohormonal stress axes activity were measured. Because tDCS-induced brain energy consumption has been shown to be part of the mechanism underlying the assumed effects, we monitored the cerebral high-energy phosphates ATP and phosphocreatine by 31 phosphorus magnetic resonance spectroscopy. As hypothesised, analyses revealed that double anodal tDCS persistently increases glucose tolerance compared to sham. Moreover, we observed a significant rise in cerebral high-energy phosphate content upon double tDCS. Accordingly, the activity of the neurohormonal stress axes was reduced upon tDCS compared to sham. Our data demonstrate that double tDCS promotes systemic glucose uptake and reduces stress axes activity in healthy humans. These effects suggest that repetitive tDCS may be a future non-pharmacological option for combating glucose intolerance in type 2 diabetes patients.
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Affiliation(s)
- Ewelina K Wardzinski
- Section of Psychoneurobiology, Center of Brain, Behavior and Metabolism, University of Luebeck, Luebeck, Germany
| | - Lisa Friedrichsen
- Section of Psychoneurobiology, Center of Brain, Behavior and Metabolism, University of Luebeck, Luebeck, Germany
| | - Sina Dannenberger
- Section of Psychoneurobiology, Center of Brain, Behavior and Metabolism, University of Luebeck, Luebeck, Germany
| | - Alina Kistenmacher
- Section of Psychoneurobiology, Center of Brain, Behavior and Metabolism, University of Luebeck, Luebeck, Germany
| | - Uwe H Melchert
- Section of Psychoneurobiology, Center of Brain, Behavior and Metabolism, University of Luebeck, Luebeck, Germany
| | - Kamila Jauch-Chara
- Section of Psychoneurobiology, Center of Brain, Behavior and Metabolism, University of Luebeck, Luebeck, Germany
| | - Kerstin M Oltmanns
- Section of Psychoneurobiology, Center of Brain, Behavior and Metabolism, University of Luebeck, Luebeck, Germany
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PsychotherapyPlus: augmentation of cognitive behavioral therapy (CBT) with prefrontal transcranial direct current stimulation (tDCS) in major depressive disorder-study design and methodology of a multicenter double-blind randomized placebo-controlled trial. Eur Arch Psychiatry Clin Neurosci 2018; 268:797-808. [PMID: 29214483 DOI: 10.1007/s00406-017-0859-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/02/2017] [Indexed: 01/20/2023]
Abstract
Major Depressive Disorder (MDD) is one of the most prevalent psychiatric disorders worldwide. About 20-30% of patients do not respond to the standard psychopharmacological and/or psychotherapeutic interventions. Mounting evidence from neuroimaging studies in MDD patients reveal altered activation patterns in lateral prefrontal brain areas. Successful cognitive behavioral therapy (CBT) is associated with a recovery of these neural alterations. Moreover, it has been demonstrated that transcranial direct current stimulation (tDCS) is capable of influencing prefrontal cortex activity and cognitive functions such as working memory and emotion regulation. Thus, a clinical trial investigating the effects of an antidepressant intervention combining CBT with tDCS seems promising. The present study investigates the antidepressant efficacy of a combined CBT-tDCS intervention as compared to CBT with sham-tDCS or CBT alone. A total of 192 patients (age range 20-65 years) with MDD (Hamilton Depression Rating Scale Score ≥ 15, 21-item version) will be recruited at four study sites across Germany (Berlin, Munich, Tuebingen, and Freiburg) and randomly assigned to one of the following three treatment arms: (1) CBT + active tDCS; (2) CBT + sham-tDCS; and (3) CBT alone. All participants will attend a 6-week psychotherapeutic intervention comprising 12 sessions of CBT each lasting 100 min in a closed group setting. tDCS will be applied simultaneously with CBT. Active tDCS includes stimulation with an intensity of 2 mA for 30 min with the anode placed over F3 and the cathode over F4 according to the EEG 10-20 system, if assigned. The primary outcome measure is the change in Montgomery-Åsberg Depression Rating Scale scores from baseline to 6, 18, and 30 weeks after the first session. Participants also undergo pre- and post-treatment neuropsychological testing and functional magnetic resonance imaging (fMRI) to assess changes in prefrontal functioning and connectivity. The study investigates whether CBT can be augmented by non-invasive brain stimulation techniques such as tDCS in the treatment of MDD. It is designed as a proof-of-principle trial for the combined tDCS-CBT treatment, but also allows the investigation of the neurobiological underpinnings of the interaction between both interventions in MDD. Trial registration ClinicalTrials.gov Identifier NCT02633449.
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Sauvaget A, Tostivint A, Etcheverrigaray F, Pichot A, Dert C, Schirr-Bonnais S, Clouet J, Sellal O, Mauduit N, Leux C, Cabelguen C, Bulteau S, Riche VP. Hospital production cost of transcranial direct current stimulation (tDCS) in the treatment of depression. Neurophysiol Clin 2018; 49:11-18. [PMID: 30502122 DOI: 10.1016/j.neucli.2018.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Due to its ease of use, tolerance, and cost of acquisition, transcranial direct current stimulation (tDCS) could constitute a credible therapeutic option for non-resistant depression in primary care, when combined with drug management. This indication has yet to receive official recognition in France. The objective of this study is to evaluate the production cost of tDCS for the treatment of depression in hospitals, under realistic conditions. METHODS The methodology adopted is based on cost accounting and was validated by a multidisciplinary working group. It includes equipment, staff, and structural costs to obtain the most realistic estimate possible. We first estimated the cost of producing a tDCS session, based on our annual activity objective, and then estimated the cost of a 15-session treatment program. This was followed up with a sensitivity analysis applying appropriate parameters. RESULTS The hospital production cost of a tDCS depression treatment program for a single patient was estimated at €1555.60 euros: €99 in equipment costs, €1076.95 in staff costs, and €379.65 in structural costs. CONCLUSION This cost analysis should make it possible to draw up pricing proposals in compliance with regulations and health policy choices and to develop health-economic studies. This would ultimately lead to official recognition of tDCS treatment for depression in France and pave the way for studying various scenarios of coverage by the French national health insurance system.
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Affiliation(s)
- Anne Sauvaget
- Addictology and liaison psychiatry department, Nantes university hospital, CHU de Nantes, Nantes, France; Laboratory "movement, interactions, performance" (EA 4334), faculty of sport sciences, university of Nantes, Nantes, France.
| | - Agathe Tostivint
- Addictology and liaison psychiatry department, Nantes university hospital, CHU de Nantes, Nantes, France
| | | | - Anne Pichot
- Addictology and liaison psychiatry department, Nantes university hospital, CHU de Nantes, Nantes, France
| | - Cécile Dert
- Innovation cell, partnership and innovation department, directorate of medical affairs and research, CHU de Nantes, Nantes, France
| | - Solène Schirr-Bonnais
- Innovation cell, partnership and innovation department, directorate of medical affairs and research, CHU de Nantes, Nantes, France
| | - Johann Clouet
- INSERM, UMR 1229, RMeS, regenerative medicine and skeleton, université de Nantes, ONIRIS, 44042 Nantes, France; Pharmacie Centrale, CHU Nantes, PHU 11, 44093 Nantes, France; UFR sciences biologiques et pharmaceutiques, université de Nantes, 44035 Nantes, France; UFR odontologie, université de Nantes, 44042 Nantes, France
| | - Olivier Sellal
- Pharmacie Centrale, CHU Nantes, PHU 11, 44093 Nantes, France
| | - Nicolas Mauduit
- Department of medical information, CHU de Nantes, Nantes, France
| | - Christophe Leux
- Department of medical information, CHU de Nantes, Nantes, France
| | - Clémence Cabelguen
- Addictology and liaison psychiatry department, Nantes university hospital, CHU de Nantes, Nantes, France
| | - Samuel Bulteau
- Addictology and liaison psychiatry department, Nantes university hospital, CHU de Nantes, Nantes, France; Inserm U1246 Sphere "methodS in Patient-centered outcomes and HEalth ResEarch", Nantes university, institute of health research IRS, 44200 Nantes, France
| | - Valéry-Pierre Riche
- Innovation cell, partnership and innovation department, directorate of medical affairs and research, CHU de Nantes, Nantes, France
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Hadoush H, Al-Sharman A, Khalil H, Banihani SA, Al-Jarrah M. Sleep Quality, Depression, and Quality of Life After Bilateral Anodal Transcranial Direct Current Stimulation in Patients with Parkinson's Disease. Med Sci Monit Basic Res 2018; 24:198-205. [PMID: 30449881 PMCID: PMC6259567 DOI: 10.12659/msmbr.911411] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Sleep dysfunctions impose a large burden on quality of life for patients with Parkinson’s disease (PD). Several studies on PD reported potential therapeutic effects of transcranial direct current stimulation (tDCS) on motor and non-motor functions, but not related to sleep quality. Therefore, the present study examined sleep quality, depression perception, and quality of life changes after bilateral anodal tDCS in patients with PD. Material/Methods Twenty-one patients (n=21) with PD underwent 10 sessions (20 min each, 5 per week) of bilateral anodal tDCS stimulation applied simultaneously over the left and right prefrontal and motor areas. The Pittsburgh Sleep Quality Index (PSQI) total score and sub-scores, Geriatric Depression Scale (GDS), and Health-related quality of life questionnaire (SF-36) were measured pre/post bilateral tDCS anodal stimulation. Results PSQI total score (P=0.045), sleep latency sub-score (P=0.02), and GDS total score (P=0.016) significantly decreased, and physical and mental components scores of SF-36 (P=0.018 and P=0.001, respectively) significantly increased after bilateral anodal tDCS stimulation. The GDS score decrease was directly correlated with decrease in PSQI total score (P=0.01), sleep latency sub-score (P=0.002), and sleep disturbance sub-score (P=0.003). In addition, the GDS score decrease was inversely correlated with increasing mental component score of SF-36 (P=0.001), which was directly correlated with an increase in sleep efficiency sub-score (P=0.03) and the physical component score of SF-36 (P=0.0001). Conclusions Bilateral anodal tDCS stimulation showed potential therapeutic effects in patients with PD in terms of sleep quality and depression level improvement, which together improved mental and physical quality of life in patients with PD.
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Affiliation(s)
- Hikmat Hadoush
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences at Jordan University of Science and Technology, Irbid, Jordan
| | - Alham Al-Sharman
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences at Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences at Jordan University of Science and Technology, Irbid, Jordan
| | - Saleem A Banihani
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences at Jordan University of Science and Technology, Irbid, Jordan
| | - Muhammed Al-Jarrah
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences at Jordan University of Science and Technology, Irbid, Jordan
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Ghaffari H, Yoonessi A, Darvishi MJ, Ahmadi A. Normal Electrical Activity of the Brain in Obsessive-Compulsive Patients After Anodal Stimulation of the Left Dorsolateral Prefrontal Cortex. Basic Clin Neurosci 2018; 9:135-146. [PMID: 29967673 PMCID: PMC6026096 DOI: 10.29252/nirp.bcn.9.2.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Transcranial Direct Current Stimulation (tDCS) has been used as a non-invasive method to increase the plasticity of brain. Growing evidence has shown several brain disorders such as depression, anxiety disorders, and chronic pain syndrome are improved following tDCS. In patients with Obsessive-Compulsive Disorder (OCD), increased brain rhythm activity particularly in the frontal lobe has been reported in several studies using Eectroencephalogram (EEG). To our knowledge, no research has been done on the effects of electrical stimulation on brain signals of patients with OCD. We measured the electrical activity of the brain using EEG in patients with OCD before and after tDCS and compared it to normal participants. Methods: Eight patients with OCD (3 males) and 8 matched healthy controls were recruited. A 64-channel EEG was used to record a 5-min resting state before and after application of tDCS in both groups. The intervention of tDCS was applied for 15 minutes with 2 mA amplitude where anode was placed on the left Dorsolateral Prefrontal Cortex (DLPFC) and cathode on the right DLPFC. Results: In line with previous studies, the results showed that the power of Delta frequency band in OCD patients are significantly higher than the normal group. Following anodal tDCS, hyperactivity in Delta and Theta bands declined in most channels, particularly in DLPFC (F3, F4) and became similar to normal signals pattern. The reduction in Delta band was significantly more than the other bands. Conclusion: Anodal tDCS over the left DLPFC significantly decreased the power of frequency bands of Delta and Theta in Patients with OCD. The pattern of EEG activity after tDCS became particularly similar to normal, so tDCS may have potential clinical application in these patients.
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Affiliation(s)
- Hamidreza Ghaffari
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Yoonessi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Darvishi
- Department of Biomedical Engineering, Faculty of Engineering, Shahed University, Tehran, Iran
| | - Akbar Ahmadi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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To WT, De Ridder D, Hart J, Vanneste S. Changing Brain Networks Through Non-invasive Neuromodulation. Front Hum Neurosci 2018; 12:128. [PMID: 29706876 PMCID: PMC5908883 DOI: 10.3389/fnhum.2018.00128] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/19/2018] [Indexed: 01/10/2023] Open
Abstract
Background/Objective: Non-invasive neuromodulation techniques, such as repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS), have increasingly been investigated for their potential as treatments for neurological and psychiatric disorders. Despite widespread dissemination of these techniques, the underlying therapeutic mechanisms and the ideal stimulation site for a given disorder remain unknown. Increasing evidence support the possibility of non-invasive neuromodulation affecting a brain network rather than just the local stimulation target. In this article, we present evidence in a clinical setting to support the idea that non-invasive neuromodulation changes brain networks. Method: This article addresses the idea that non-invasive neuromodulation modulates brain networks, rather than just the local stimulation target, using neuromodulation studies in tinnitus and major depression as examples. We present studies that support this hypothesis from different perspectives. Main Results/Conclusion: Studies stimulating the same brain region, such as the dorsolateral prefrontal cortex (DLPFC), have shown to be effective for several disorders and studies using different stimulation sites for the same disorder have shown similar results. These findings, as well as results from studies investigating brain network connectivity on both macro and micro levels, suggest that non-invasive neuromodulation affects a brain network rather than just the local stimulation site targeted. We propose that non-invasive neuromodulation should be approached from a network perspective and emphasize the therapeutic potential of this approach through the modulation of targeted brain networks.
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Affiliation(s)
- Wing Ting To
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - John Hart
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Sven Vanneste
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
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Eapen V, Baker R, Walter A, Raghupathy V, Wehrman JJ, Sowman PF. The Role of Transcranial Direct Current Stimulation (tDCS) in Tourette Syndrome: A Review and Preliminary Findings. Brain Sci 2017; 7:brainsci7120161. [PMID: 29292730 PMCID: PMC5742764 DOI: 10.3390/brainsci7120161] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/27/2017] [Accepted: 12/05/2017] [Indexed: 12/24/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that is being investigated for a variety of neurological and psychiatric conditions. Preliminary evidence suggests that tDCS may be useful in the treatment of Tourette Syndrome (TS). This paper reviews the literature on the use of tDCS in commonly occurring comorbid conditions that are relevant to its proposed use in TS. We describe the protocol for a double-blind, crossover, sham-controlled trial of tDCS (Trial ID: ACTRN12615000592549, registered at www.anzctr.org.au) investigating the efficacy, feasibility, safety, and tolerability of tDCS in patients with TS aged 12 years and over. The intervention consists of cathodal tDCS positioned over the Supplementary Motor Area. Patients receive either sham tDCS for three weeks followed by six weeks of active tDCS (1.4 mA, 18 sessions over six weeks), or six weeks of active sessions followed by three weeks of sham sessions, with follow-up at three and six months. Pilot findings from two patients are presented. There was a reduction in the frequency and intensity of patients’ tics and premonitory urges, as well as evidence of improvements in inhibitory function, over the course of treatment. Larger scale studies are indicated to ascertain the maintenance of symptom improvement over time, as well as the long-term consequences of the repetitions of sessions.
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Affiliation(s)
- Valsamma Eapen
- Academic Unit of Child Psychiatry South West Sydney and Ingham Institute, Liverpool Hospital, Sydney 2170, Australia.
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney 2052, Australia.
| | - Richard Baker
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney 2052, Australia.
- The Sydney Children's Hospital at Randwick, Sydney 2031, Australia.
| | - Amelia Walter
- Academic Unit of Child Psychiatry South West Sydney and Ingham Institute, Liverpool Hospital, Sydney 2170, Australia.
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney 2052, Australia.
| | | | - Jordan J Wehrman
- Department of Cognitive Science, Macquarie University, Sydney 2109, Australia.
- Perception and Action Research Centre, Faculty of Human Sciences, Macquarie University, Sydney 2109, Australia.
- ARC Centre of Excellence for Cognition and Its Disorders (CCD), Sydney 2109, Australia.
| | - Paul F Sowman
- Department of Cognitive Science, Macquarie University, Sydney 2109, Australia.
- Perception and Action Research Centre, Faculty of Human Sciences, Macquarie University, Sydney 2109, Australia.
- ARC Centre of Excellence for Cognition and Its Disorders (CCD), Sydney 2109, Australia.
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Colpo GD, Leboyer M, Dantzer R, Trivedi MH, Teixeira AL. Immune-based strategies for mood disorders: facts and challenges. Expert Rev Neurother 2017; 18:139-152. [PMID: 29179585 DOI: 10.1080/14737175.2018.1407242] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Inflammation seems to play a role in the pathophysiology of mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD). In the last years several studies have shown increased levels of inflammatory and/or immune markers in patients with mood disorders. Accordingly, the immune system has become a target of interest for the development of biomarkers and therapeutics for mood disorders. Areas covered: Here, we review the evidence showing low-grade inflammation in mood disorders and the studies evaluating immune-based strategies for the treatment of these conditions. Expert commentary: Clinical trials with non-steroidal anti-inflammatory drugs, polyunsaturated acids, N-acetylcysteine, anti-cytokines, physical activity and probiotics have provided promising results in terms of antidepressant efficacy in patients with MDD and BD. Regarding stem cells, only studies with animal models have been performed so far with interesting pre-clinical results. Due to the preliminary nature of the results, most of the clinical studies need to be replicated and/or confirmed in larger clinical settings, embracing the highly heterogeneous pathophysiology of mood disorders.
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Affiliation(s)
- Gabriela D Colpo
- a Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School , The University of Texas Health Science Center at Houston - UT Health , Houston , TX , USA
| | - Marion Leboyer
- b Inserm U 955, Department of Psychiatry, AP-HP, DHU PePSY, Groupe Hosp italier Henri Mondor , Créteil University Paris Est Créteil , Paris , France
| | - Robert Dantzer
- c Division of Internal Medicine, Department of Symptom Research , MD Anderson Cancer Center , Houston , TX , USA
| | - Mahdukar H Trivedi
- d Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Antonio L Teixeira
- a Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School , The University of Texas Health Science Center at Houston - UT Health , Houston , TX , USA
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Borrione L, Brunoni AR. Primum non nocere or primum facere meliorem? Hacking the brain in the 21st century. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2017; 39:232-238. [DOI: 10.1590/2237-6089-2017-0075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/16/2017] [Indexed: 11/21/2022]
Abstract
Abstract Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that modulates cortical excitability. It is devoid of serious adverse events and exerts variable effects on cognition, with several research findings suggesting that it can improve memory, verbal and mathematical skills. Because tDCS devices are low-cost, portable and relatively easy to assemble, they have become available outside of the medical setting and used for non-medical (“cosmetic”) purposes by laypersons. In this sense, tDCS has become a popular technique aiming to improve cognition and the achievement of a better performance not only at work, but also in other fields such as sports, leisure activities (video games) and even the military. In spite of these unforeseen developments, there has been a general paralysis of the medical and regulatory agencies to develop guidelines for the use of tDCS for cosmetic purposes. Several challenges are present, most importantly, how to restrict tDCS use outside of the medical setting in face of variable and sometimes conflicting results from scientific research. This article aims to describe the popular use of tDCS, in light of the pillars of neuroethics, a branch of bioethics relative to brain research. Between two possible but extreme solutions – total release or total restriction of tDCS – it is paramount to develop a spectrum of alternatives, which may vary over time and in different cultural backgrounds.
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Affiliation(s)
| | - Andre R. Brunoni
- Universidade de São Paulo, Brazil; Ludwig-Maximilians-University, Germany
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Acute and repetitive fronto-cerebellar tDCS stimulation improves mood in non-depressed participants. Exp Brain Res 2017; 236:83-97. [PMID: 29098314 DOI: 10.1007/s00221-017-5109-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/16/2017] [Indexed: 01/28/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive form of brain stimulation, which allows for selective inhibition or excitation of neural structures. It has demonstrated some efficacy in the treatment of mood disorders. However, these studies have predominately focused on stimulation of the prefrontal cortex (PFC). The cerebellum has an increasingly recognized role in emotional control, affective state, and some psychopathologies. As such, tDCS research into mood modulation needs to expand beyond conventional PFC-focused paradigms. Using a contralateral stimulation electrode placement [anodal left dorsolateral(dl)PFC, cathodal right cerebellum], and a single-blind, repeated-measures design, we initially assessed changes in the mood of healthy participants in response to acute stimulation (n = 44) and three repeated stimulations delivered second-daily (n = 21). In a second experiment, we separately investigated the influence of reversed polarity upon these same measures, in response to acute stimulation (n = 23) and repeated stimulation (n = 11). We observed a systematic elevation of mood in both active conditions following single and repeated tDCS, the latter of which displayed a progressive elevation of mood from baseline. No mood change was noted in response to either single or repeated stimulation in the sham condition. Frontocerebellar tDCS stimulation advantageously influences mood in healthy participants, with an accumulative and potentiated effect following successive stimulations. The possibility that frontocerebellar stimulation may provide a novel therapeutic adjunctive or pre-emptive intervention in stress-related disorders and mood-related psychopathologies should be considered.
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Pedron S, Beverley J, Haffen E, Andrieu P, Steiner H, Van Waes V. Transcranial direct current stimulation produces long-lasting attenuation of cocaine-induced behavioral responses and gene regulation in corticostriatal circuits. Addict Biol 2017; 22:1267-1278. [PMID: 27265728 DOI: 10.1111/adb.12415] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 04/28/2016] [Accepted: 05/04/2016] [Indexed: 12/20/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive method to modulate cortical excitability. This technique is a promising emerging tool to treat several neuropathologies, including addiction. We have previously shown in mice that repeated tDCS normalizes pathological behaviors associated with chronic nicotine exposure. Here, we evaluated, in adult female mice, the impact of tDCS on cocaine-induced behavior and gene regulation in corticostriatal circuits implicated in psychostimulant addiction. Anodal tDCS was applied transcranially over the frontal cortex. Three weeks after repeated tDCS, we investigated the induction of a gene expression marker (Zif268) by cocaine (25 mg/kg) in 26 cortical and 23 striatal regions using in situ hybridization histochemistry. We also assessed place preference conditioning by cocaine (5, 10 and 25 mg/kg). tDCS pretreatment increased basal expression and attenuated cocaine (25 mg/kg)-induced expression of Zif268 in specific corticostriatal circuits. Cocaine-induced locomotor activation (25 mg/kg) and place preference conditioning (5 and 25 mg/kg) were also reduced. These results demonstrate that tDCS can attenuate molecular and behavioral responses to cocaine for several weeks. Together, our findings provide pre-clinical evidence that such electrical brain stimulation may be useful to modify the psychostimulant addiction risk.
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Affiliation(s)
- Solène Pedron
- EA 481 Laboratory of Integrative and Clinical Neuroscience; University of Franche-Comté/SFR FED 4234, COMUE Bourgogne/Franche-Comté; France
| | - Joel Beverley
- Department of Cellular and Molecular Pharmacology, The Chicago Medical School; Rosalind Franklin University of Medicine and Science; North Chicago IL USA
| | - Emmanuel Haffen
- EA 481 Laboratory of Integrative and Clinical Neuroscience; University of Franche-Comté/SFR FED 4234, COMUE Bourgogne/Franche-Comté; France
- INSERM CIC-IT 808 Clinical Investigation Centre for Innovative Technology; University Hospital of Besançon; France
| | - Patrice Andrieu
- EA 481 Laboratory of Integrative and Clinical Neuroscience; University of Franche-Comté/SFR FED 4234, COMUE Bourgogne/Franche-Comté; France
| | - Heinz Steiner
- Department of Cellular and Molecular Pharmacology, The Chicago Medical School; Rosalind Franklin University of Medicine and Science; North Chicago IL USA
| | - Vincent Van Waes
- EA 481 Laboratory of Integrative and Clinical Neuroscience; University of Franche-Comté/SFR FED 4234, COMUE Bourgogne/Franche-Comté; France
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Multifocal tDCS targeting the resting state motor network increases cortical excitability beyond traditional tDCS targeting unilateral motor cortex. Neuroimage 2017; 157:34-44. [PMID: 28572060 DOI: 10.1016/j.neuroimage.2017.05.060] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/08/2017] [Accepted: 05/27/2017] [Indexed: 01/28/2023] Open
Abstract
Scientists and clinicians have traditionally targeted single brain regions with stimulation to modulate brain function and disease. However, brain regions do not operate in isolation, but interact with other regions through networks. As such, stimulation of one region may impact and be impacted by other regions in its network. Here we test whether the effects of brain stimulation can be enhanced by simultaneously targeting a region and its network, identified with resting state functional connectivity MRI. Fifteen healthy participants received two types of transcranial direct current stimulation (tDCS): a traditional two-electrode montage targeting a single brain region (left primary motor cortex [M1]) and a novel eight-electrode montage targeting this region and its associated resting state network. As a control, 8 participants also received multifocal tDCS mismatched to this network. Network-targeted tDCS more than doubled the increase in left M1 excitability over time compared to traditional tDCS and the multifocal control. Modeling studies suggest these results are unlikely to be due to tDCS effects on left M1 itself, however it is impossible to completely exclude this possibility. It also remains unclear whether multifocal tDCS targeting a network selectively modulates this network and which regions within the network are most responsible for observed effects. Despite these limitations, network-targeted tDCS appears to be a promising approach for enhancing tDCS effects beyond traditional stimulation targeting a single brain region. Future work is needed to test whether these results extend to other resting state networks and enhance behavioral or therapeutic effects.
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van Steenburgh JJ, Varvaris M, Schretlen DJ, Vannorsdall TD, Gordon B. Balanced bifrontal transcranial direct current stimulation enhances working memory in adults with high-functioning autism: a sham-controlled crossover study. Mol Autism 2017; 8:40. [PMID: 28775825 PMCID: PMC5534041 DOI: 10.1186/s13229-017-0152-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 06/16/2017] [Indexed: 11/20/2022] Open
Abstract
Background Working memory (WM) often is impaired in autism spectrum disorder (ASD). Such impairment may underlie core deficits in cognition and social functioning. Transcranial direct current stimulation (tDCS) has been shown to enhance WM in both healthy adults and clinical populations, but its efficacy in ASD is unknown. We predicted that bifrontal tDCS would improve WM performances of adults with high-functioning autism during active stimulation compared to sham stimulation and that such enhancement would generalize to an untrained task. Methods Twelve adults with high-functioning ASD engaged in a battery of WM tasks that included backward spatial span, backward digit span, spatial n-back and letter n-back. While engaged, 40 min of 1.5 mA bifrontal stimulation was applied over the left and the right dorsolateral prefrontal cortices (DLPFC). Using a single-blind crossover design, each participant received left anodal/right cathodal stimulation, right anodal/left cathodal stimulation, or sham stimulation, in randomized counterbalanced order on three separate days. Following tDCS, participants again engaged in letter and spatial n-back tasks before taking the Brief Test of Attention (BTA). We used repeated-measures ANOVA to compare overall performance on the WM battery as measured by a composite of z-scores for all five measures. Post hoc ANOVAs, t tests, Friedman’s tests, and Wilcoxon signed-rank tests were used to measure the online and offline effects of tDCS and to assess performances on individual measures. Results Compared to sham stimulation, both left DLPFC anodal stimulation (t11 = 5.4, p = 0.0002) and right DLPFC anodal stimulation (t11 = 3.57, p = 0.004) improved overall WM performance. Left anodal stimulation (t11 = 3.9, p = 0.003) and right anodal stimulation (t11 = 2.7, p = 0.019) enhanced performances during stimulation. Enhancement transferred to an untrained task 50 min after right anodal stimulation (z11 = 2.263, p = 0.024). The tasks that showed the largest effects of active stimulation were spatial span backward (z11 = 2.39, p = 0.017) and BTA (z11 = 2.263, p = 0.024). Conclusions In adults with high-functioning ASD, active bifrontal tDCS given during WM tasks appears to improve performance. TDCS benefits also transferred to an untrained task completed shortly after stimulation. These results suggest that tDCS can improve WM task performance and could reduce some core deficits of autism. Trial registration NCT01602263
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Affiliation(s)
- J Jason van Steenburgh
- Department of Neurology, The Johns Hopkins University School of Medicine, 1629 Thames Street, Suite 350, Baltimore, MD 21231 USA
| | - Mark Varvaris
- Department of Neurology, The Johns Hopkins University School of Medicine, 1629 Thames Street, Suite 350, Baltimore, MD 21231 USA
| | - David J Schretlen
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287 USA.,Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, 600 N. Wolfe Street, Baltimore, MD 21287 USA
| | - Tracy D Vannorsdall
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287 USA.,Department of Neurology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287 USA
| | - Barry Gordon
- Department of Neurology, The Johns Hopkins University School of Medicine, 1629 Thames Street, Suite 350, Baltimore, MD 21231 USA
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Veniero D, Benwell CSY, Ahrens MM, Thut G. Inconsistent Effects of Parietal α-tACS on Pseudoneglect across Two Experiments: A Failed Internal Replication. Front Psychol 2017. [PMID: 28642729 PMCID: PMC5463322 DOI: 10.3389/fpsyg.2017.00952] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Transcranial electrical stimulation (tES) is being investigated as an experimental and clinical interventional technique in human participants. While promising, important limitations have been identified, including weak effect sizes and high inter- and intra-individual variability of outcomes. Here, we compared two "inhibitory" tES-techniques with supposedly different mechanisms of action as to their effects on performance in a visuospatial attention task, and report on a direct replication attempt. In two experiments, 2 × 20 healthy participants underwent tES in three separate sessions testing different protocols (10 min stimulation each) with a montage targeting right parietal cortex (right parietal-left frontal, electrode-sizes: 3cm × 3cm-7 cm × 5 cm), while performing a perceptual line bisection (landmark) task. The tES-protocols were compared as to their ability to modulate pseudoneglect (thought to be under right hemispheric control). In experiment 1, sham-tES was compared to transcranial alternating current stimulation at alpha frequency (10 Hz; α-tACS) (expected to entrain "inhibitory" alpha oscillations) and to cathodal transcranial direct current stimulation (c-tDCS) (shown to suppress neuronal spiking activity). In experiment 2, we attempted to replicate the findings of experiment 1, and establish frequency-specificity by adding a 45 Hz-tACS condition to α-tACS and sham. In experiment 1, right parietal α-tACS led to the expected changes in spatial attention bias, namely a rightward shift in subjective midpoint estimation (relative to sham). However, this was not confirmed in experiment 2 and in the complete sample. Right parietal c-tDCS and 45 Hz-tACS had no effect. These results highlight the importance of replication studies, adequate statistical power and optimizing tES-interventions for establishing the robustness and reliability of electrical stimulation effects, and best practice.
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Affiliation(s)
- Domenica Veniero
- Institute of Neuroscience and Psychology, University of GlasgowGlasgow, United Kingdom
| | | | - Merle M Ahrens
- Institute of Neuroscience and Psychology, University of GlasgowGlasgow, United Kingdom.,School of Psychology, University of GlasgowGlasgow, United Kingdom
| | - Gregor Thut
- Institute of Neuroscience and Psychology, University of GlasgowGlasgow, United Kingdom
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Zhao H, Qiao L, Fan D, Zhang S, Turel O, Li Y, Li J, Xue G, Chen A, He Q. Modulation of Brain Activity with Noninvasive Transcranial Direct Current Stimulation (tDCS): Clinical Applications and Safety Concerns. Front Psychol 2017; 8:685. [PMID: 28539894 PMCID: PMC5423956 DOI: 10.3389/fpsyg.2017.00685] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 04/19/2017] [Indexed: 11/13/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a widely-used tool to induce neuroplasticity and modulate cortical function by applying weak direct current over the scalp. In this review, we first introduce the underlying mechanism of action, the brief history from discovery to clinical scientific research, electrode positioning and montages, and parameter setup of tDCS. Then, we review tDCS application in clinical samples including people with drug addiction, major depression disorder, Alzheimer's disease, as well as in children. This review covers the typical characteristics and the underlying neural mechanisms of tDCS treatment in such studies. This is followed by a discussion of safety, especially when the current intensity is increased or the stimulation duration is prolonged. Given such concerns, we provide detailed suggestions regarding safety procedures for tDCS operation. Lastly, future research directions are discussed. They include foci on the development of multi-tech combination with tDCS such as with TMS and fMRI; long-term behavioral and morphological changes; possible applications in other research domains, and more animal research to deepen the understanding of the biological and physiological mechanisms of tDCS stimulation.
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Affiliation(s)
- Haichao Zhao
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Lei Qiao
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Dongqiong Fan
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Shuyue Zhang
- School of Education, Guangxi UniversityNanning, China
| | - Ofir Turel
- Department of Information systems and Decision Sciences, College of Business and Economics, California State University, FullertonFullerton, CA, USA
| | - Yonghui Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijing, China
| | - Jun Li
- National Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
| | - Gui Xue
- National Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
| | - Antao Chen
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Qinghua He
- Faculty of Psychology, Southwest UniversityChongqing, China.,Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijing, China.,Southwest University Branch, Collaborative Innovation Center of Assessment toward Basic Education Quality at Beijing Normal UniversityChongqing, China
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45
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Spagnolo PA, Goldman D. Neuromodulation interventions for addictive disorders: challenges, promise, and roadmap for future research. Brain 2017; 140:1183-1203. [PMID: 28082299 PMCID: PMC6059187 DOI: 10.1093/brain/aww284] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/24/2016] [Accepted: 09/12/2016] [Indexed: 01/27/2023] Open
Abstract
Addictive disorders are a major public health concern, associated with high relapse rates, significant disability and substantial mortality. Unfortunately, current interventions are only modestly effective. Preclinical studies as well as human neuroimaging studies have provided strong evidence that the observable behaviours that characterize the addiction phenotype, such as compulsive drug consumption, impaired self-control, and behavioural inflexibility, reflect underlying dysregulation and malfunction in specific neural circuits. These developments have been accompanied by advances in neuromodulation interventions, both invasive as deep brain stimulation, and non-invasive such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation. These interventions appear particularly promising as they may not only allow us to probe affected brain circuits in addictive disorders, but also seem to have unique therapeutic applications to directly target and remodel impaired circuits. However, the available literature is still relatively small and sparse, and the long-term safety and efficacy of these interventions need to be confirmed. Here we review the literature on the use of neuromodulation in addictive disorders to highlight progress limitations with the aim to suggest future directions for this field.
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Affiliation(s)
- Primavera A Spagnolo
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
| | - David Goldman
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
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46
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Junghofer M, Winker C, Rehbein MA, Sabatinelli D. Noninvasive Stimulation of the Ventromedial Prefrontal Cortex Enhances Pleasant Scene Processing. Cereb Cortex 2017; 27:3449-3456. [DOI: 10.1093/cercor/bhx073] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/06/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Markus Junghofer
- Institute for Biomagnetism and Biosignal Analysis and Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, 48149 Muenster, Germany
| | - Constantin Winker
- Institute for Biomagnetism and Biosignal Analysis and Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, 48149 Muenster, Germany
| | - Maimu A. Rehbein
- Institute for Biomagnetism and Biosignal Analysis and Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, 48149 Muenster, Germany
| | - Dean Sabatinelli
- Department of Psychology & Neuroscience, BioImaging Research Center, University of Georgia, Athens, GA 30602, USA
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47
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Norise C, Hamilton RH. Non-invasive Brain Stimulation in the Treatment of Post-stroke and Neurodegenerative Aphasia: Parallels, Differences, and Lessons Learned. Front Hum Neurosci 2017; 10:675. [PMID: 28167904 PMCID: PMC5253356 DOI: 10.3389/fnhum.2016.00675] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/19/2016] [Indexed: 11/22/2022] Open
Abstract
Numerous studies over the span of more than a decade have shown that non-invasive brain stimulation (NIBS) techniques, namely transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), can facilitate language recovery for patients who have suffered from aphasia due to stroke. While stroke is the most common etiology of aphasia, neurodegenerative causes of language impairment—collectively termed primary progressive aphasia (PPA)—are increasingly being recognized as important clinical phenotypes in dementia. Very limited data now suggest that (NIBS) may have some benefit in treating PPAs. However, before applying the same approaches to patients with PPA as have previously been pursued in patients with post-stroke aphasia, it will be important for investigators to consider key similarities and differences between these aphasia etiologies that is likely to inform successful approaches to stimulation. While both post-stroke aphasia and the PPAs have clear overlaps in their clinical phenomenology, the mechanisms of injury and theorized neuroplastic changes associated with the two etiologies are notably different. Importantly, theories of plasticity in post-stroke aphasia are largely predicated on the notion that regions of the brain that had previously been uninvolved in language processing may take on new compensatory roles. PPAs, however, are characterized by slow distributed degeneration of cellular units within the language system; compensatory recruitment of brain regions to subserve language is not currently understood to be an important aspect of the condition. This review will survey differences in the mechanisms of language representation between the two etiologies of aphasia and evaluate properties that may define and limit the success of different neuromodulation approaches for these two disorders.
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Affiliation(s)
- Catherine Norise
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania Philadelphia, PA, USA
| | - Roy H Hamilton
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania Philadelphia, PA, USA
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Shiozawa P, Soares A, Taiar I, Dias ÁM, Cordeiro Q. Transcranial direct current stimulation (tDCS): Are we losing energy? Epilepsy Behav 2017; 66:138-139. [PMID: 27979410 DOI: 10.1016/j.yebeh.2016.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 10/13/2016] [Accepted: 10/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Pedro Shiozawa
- Evidence-based Psychiatry Unit, Santa Casa Medical School, São Paulo, Brazil; Center for neuromodulation studies of the Federal University of Sao Paulo Medical School, Brazil.
| | - Amanda Soares
- Evidence-based Psychiatry Unit, Santa Casa Medical School, São Paulo, Brazil; Center for neuromodulation studies of the Federal University of Sao Paulo Medical School, Brazil
| | - Ivan Taiar
- Evidence-based Psychiatry Unit, Santa Casa Medical School, São Paulo, Brazil; Center for neuromodulation studies of the Federal University of Sao Paulo Medical School, Brazil
| | - Álvaro Machado Dias
- Clinical Neuroscience Lab of the Dept. of Psychiatry, Federal University of São Paulo, Brazil; Center for neuromodulation studies of the Federal University of Sao Paulo Medical School, Brazil
| | - Quirino Cordeiro
- Evidence-based Psychiatry Unit, Santa Casa Medical School, São Paulo, Brazil; Center for neuromodulation studies of the Federal University of Sao Paulo Medical School, Brazil
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49
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Transcriptomic Modification in the Cerebral Cortex following Noninvasive Brain Stimulation: RNA-Sequencing Approach. Neural Plast 2016; 2016:5942980. [PMID: 28119786 PMCID: PMC5227175 DOI: 10.1155/2016/5942980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/27/2016] [Accepted: 11/14/2016] [Indexed: 11/18/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has been shown to modulate neuroplasticity. Beneficial effects are observed in patients with psychiatric disorders and enhancement of brain performance in healthy individuals has been observed following tDCS. However, few studies have attempted to elucidate the underlying molecular mechanisms of tDCS in the brain. This study was conducted to assess the impact of tDCS on gene expression within the rat cerebral cortex. Anodal tDCS was applied at 3 different intensities followed by RNA-sequencing and analysis. In each current intensity, approximately 1,000 genes demonstrated statistically significant differences compared to the sham group. A variety of functional pathways, biological processes, and molecular categories were found to be modified by tDCS. The impact of tDCS on gene expression was dependent on current intensity. Results show that inflammatory pathways, antidepressant-related pathways (GTP signaling, calcium ion binding, and transmembrane/signal peptide pathways), and receptor signaling pathways (serotonergic, adrenergic, GABAergic, dopaminergic, and glutamate) were most affected. Of the gene expression profiles induced by tDCS, some changes were observed across multiple current intensities while other changes were unique to a single stimulation intensity. This study demonstrates that tDCS can modify the expression profile of various genes in the cerebral cortex and that these tDCS-induced alterations are dependent on the current intensity applied.
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50
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tDCS for the treatment of depression: a comprehensive review. Eur Arch Psychiatry Clin Neurosci 2016; 266:681-694. [PMID: 26842422 DOI: 10.1007/s00406-016-0674-9] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/18/2016] [Indexed: 12/24/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been investigated for the treatment of major depressive disorders in recent years. Here, we review the implications of current research for the clinical use of tDCS in the treatment of major depressive disorder. Meta-analyses, randomized, placebo-controlled clinical trials, open-label trials, case reports and review articles were identified through a systematic search of the literature database of the National Institutes of Health (USA). Available articles were evaluated with regard to their clinical relevance. Results of tDCS efficacy are inconsistent due to the small sample sizes, the heterogeneous patient samples and the partially high treatment resistance in some studies. Overall, tDCS has very low side effects. Meta-analyses suggest some efficacy of tDCS in the treatment of acute depressive disorder with moderate effect size, and low efficacy in treatment-resistant depression. A general statement about the efficacy of tDCS as a therapeutic tool in major depression seems to be premature. tDCS is considered as a safe therapeutic option and is associated with only minor side effects. The effectiveness of tDCS decreases with resistance to treatment. Psychotropic drugs may attenuate or amplify its effects. The use of 2 mA current strength over 20 min per day over a short time span can be considered as safe.
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