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Lapenta OM, Rêgo GG, Boggio PS. Transcranial electrical stimulation for procedural learning and rehabilitation. Neurobiol Learn Mem 2024; 213:107958. [PMID: 38971460 DOI: 10.1016/j.nlm.2024.107958] [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: 01/16/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
Procedural learning is the acquisition of motor and non-motor skills through a gradual process that increases with practice. Impairments in procedural learning have been consistently demonstrated in neurodevelopmental, neurodegenerative, and neuropsychiatric disorders. Considering that noninvasive brain stimulation modulates brain activity and boosts neuroplastic mechanisms, we reviewed the effects of coupling transcranial direct current stimulation (tDCS) with training methods for motor and non-motor procedural learning to explore tDCS potential use as a tool for enhancing implicit learning in healthy and clinical populations. The review covers tDCS effects over i. motor procedural learning, from basic to complex activities; ii. non-motor procedural learning; iii. procedural rehabilitation in several clinical populations. We conclude that targeting the primary motor cortex and prefrontal areas seems the most promising for motor and non-motor procedural learning, respectively. For procedural rehabilitation, the use of tDCS is yet at an early stage but some effectiveness has been reported for implicit motor and memory learning. Still, systematic comparisons of stimulation parameters and target areas are recommended for maximising the effectiveness of tDCS and its robustness for procedural rehabilitation.
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Affiliation(s)
- Olivia Morgan Lapenta
- Psychological Neuroscience Laboratory, Psychology Research Center, School of Psychology, University of Minho - Rua da Universidade, 4710-057 Braga, Portugal.
| | - Gabriel Gaudencio Rêgo
- Social and Cognitive Neuroscience Laboratory, Mackenzie Presbyterian University - Rua Piauí, 181, 01241-001 São Paulo, Brazil; National Institute of Science and Technology on Social and Affective Neuroscience (INCT-SANI), São Paulo, Brazil
| | - Paulo Sérgio Boggio
- Social and Cognitive Neuroscience Laboratory, Mackenzie Presbyterian University - Rua Piauí, 181, 01241-001 São Paulo, Brazil; National Institute of Science and Technology on Social and Affective Neuroscience (INCT-SANI), São Paulo, Brazil
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2
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Aljeradat B, Kumar D, Abdulmuizz S, Kundu M, Almealawy YF, Batarseh DR, Atallah O, Ennabe M, Alsarafandi M, Alan A, Weinand M. Neuromodulation and the Gut-Brain Axis: Therapeutic Mechanisms and Implications for Gastrointestinal and Neurological Disorders. PATHOPHYSIOLOGY 2024; 31:244-268. [PMID: 38804299 PMCID: PMC11130832 DOI: 10.3390/pathophysiology31020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
The gut-brain axis (GBA) represents a complex, bidirectional communication network that intricately connects the gastrointestinal tract with the central nervous system (CNS). Understanding and intervening in this axis opens a pathway for therapeutic advancements for neurological and gastrointestinal diseases where the GBA has been proposed to play a role in the pathophysiology. In light of this, the current review assesses the effectiveness of neuromodulation techniques in treating neurological and gastrointestinal disorders by modulating the GBA, involving key elements such as gut microbiota, neurotrophic factors, and proinflammatory cytokines. Through a comprehensive literature review encompassing PubMed, Google Scholar, Web of Science, and the Cochrane Library, this research highlights the role played by the GBA in neurological and gastrointestinal diseases, in addition to the impact of neuromodulation on the management of these conditions which include both gastrointestinal (irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and gastroesophageal reflux disease (GERD)) and neurological disorders (Parkinson's disease (PD), Alzheimer's disease (AD), autism spectrum disorder (ASD), and neuropsychiatric disorders). Despite existing challenges, the ability of neuromodulation to adjust disrupted neural pathways, alleviate pain, and mitigate inflammation is significant in improving the quality of life for patients, thereby offering exciting prospects for future advancements in patient care.
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Affiliation(s)
- Baha’ Aljeradat
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Danisha Kumar
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Dow Medical College, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Sulaiman Abdulmuizz
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- College of Health Sciences, University of Ilorin, Ilorin 240003, Kwara, Nigeria
| | - Mrinmoy Kundu
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar 751029, India
| | - Yasser F. Almealawy
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Faculty of Medicine, University of Kufa, Kufa P.O. Box 21, Iraq
| | - Dima Ratib Batarseh
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Oday Atallah
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany
| | - Michelle Ennabe
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- College of Medicine, The University of Arizona College of Medicine, Phoenix, AZ 85004, USA
| | - Muath Alsarafandi
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- College of Medicine, Islamic University of Gaza, Rafa Refugee Camp, Rafa P.O. Box 108, Palestine
- Faculty of Medicine, Islamic University of Gaza, Gaza P.O. Box 108, Palestine
| | - Albert Alan
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Department of Neurosurgery, University of Arizona, Tucson, AZ 85724, USA;
- College of Medicine, The University of Arizona College of Medicine, Tucson, AZ 85004, USA
| | - Martin Weinand
- Department of Neurosurgery, University of Arizona, Tucson, AZ 85724, USA;
- College of Medicine, The University of Arizona College of Medicine, Tucson, AZ 85004, USA
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Orlov ND, Muqtadir SA, Oroojeni H, Averbeck B, Rothwell J, Shergill SS. Stimulating learning: A functional MRI and behavioral investigation of the effects of transcranial direct current stimulation on stochastic learning in schizophrenia. Psychiatry Res 2022; 317:114908. [PMID: 37732853 DOI: 10.1016/j.psychres.2022.114908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 04/19/2022] [Accepted: 10/13/2022] [Indexed: 11/25/2022]
Abstract
Transcranial direct current stimulation (tDCS) of the medial prefrontal cortex (mPFC) is under clinical investigation as a treatment for cognitive deficits. We investigate the effects of tDCS over the mPFC on performance SSLT in individuals with schizophrenia, and the underlying neurophysiological effect in regions associated with learning values and stimulus-outcome relationships. In this parallel-design double-blind pilot study, 49 individuals with schizophrenia, of whom 28 completed a fMRI, were randomized into active or sham tDCS stimulation groups. Subjects participated in 4 days of SSLT training (days 1, 2, 14, 56) with tDCS applied at day-1, and during a concurrent MRI scan at day-14. The SSLT demonstrated a significant mean difference in performance in the tDCS treatment group: at day-2 and at day-56. Active tDCS was associated with increased insular activity, and reduced amygdala activation. tDCS may offer an important novel approach to modulating brain networks to ameliorate cognitive deficits in schizophrenia, with this study being the first to show a longer-term effect on SSLT.
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Affiliation(s)
- Natasza D Orlov
- Cognition Schizophrenia Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Liu Lab, Athinoula A. Martinos Center for Biomedical Imaging Center, Massachusetts General Hospital, Charlestown, MA, USA; Lab of Precision Brain Imaging, Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA.
| | - Syed Ali Muqtadir
- Cognition Schizophrenia Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Lahore University of Management and Sciences, Lon, Lahore, Pakistan
| | - Hooman Oroojeni
- Department of Computing, Goldsmiths College, London, United Kingdom
| | - Bruno Averbeck
- Laboratory for Neuropsychology Section on Learning and Decision Making, National Institute of Mental Health Research, Bethesda, MD, United States
| | - John Rothwell
- Institute of Neurology, University College London, London, United Kingdom
| | - Sukhi S Shergill
- Cognition Schizophrenia Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Kent and Medway Medical School, Canterbury, United Kingdom
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Fathi Azar E, Hosseinzadeh S, Nosrat Abadi M, Sayad Nasiri M, Haghgoo HA. Impact of Psychosocial Occupational Therapy Combined with Anodal Transcranial Direct Current Stimulation to the Left Dorsolateral Prefrontal Cortex on the Cognitive Performance of Patients with Schizophrenia: A Randomized Controlled Trial. Hong Kong J Occup Ther 2022; 34:121-131. [PMID: 34987350 PMCID: PMC8721578 DOI: 10.1177/15691861211065155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background The most common cognitive dysfunctions in patients with schizophrenia are information processing, memory, and learning. Based on the hypothesis of rehabilitation and brain stimulation in memory and learning, adding a form of neuromodulation to conventional rehabilitation might increase the effectiveness of treatments. Aims To explore the effects of psychosocial occupational therapy combined with anodal Transcranial Direct Current Stimulation (tDCS) on cognitive performance in patients with Schizophrenia. Methods Twenty-four patients diagnosed with schizophrenia were randomized into the experimental and control groups. We used The Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Loewenstein Occupational Therapy Cognitive Assessment battery (LOTCA) to assess spatial recognition, attention, visual memory, learning abilities, and high-level cognitive functions like problem-solving. All participants received customized psychosocial occupational therapy activities. Furthermore, the experimental group received 12 sessions of active anodal tDCS for 20 minutes with 2 mA intensity on the left dorsolateral prefrontal cortex (DLPFC) while the patients in the sham group received sham tDCS. Results Combining tDCS to conventional psychosocial occupational therapy resulted in a significant increase in spatial memory, visual learning, and attention. Conclusions Anodal tDCS on the left DLPFC improved visual memory, attention, and learning abilities. Contrary to our expectations, we could not find any changes in complex and more demanding cognitive functions.
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Affiliation(s)
- Elahe Fathi Azar
- MSc in Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Samaneh Hosseinzadeh
- Biostatics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Masoud Nosrat Abadi
- Clinical Psychology Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohamad Sayad Nasiri
- Assistant Professor of Neurology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hojjat Allah Haghgoo
- Occupational Therapy Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Hojjat Allah Haghgoo, Occupational Therapy Department, The University of Social Welfare and Rehabilitation Sciences, Kodakyar st.,Velenjak, Tehran, 1985713871, Iran.
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5
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Bulubas L, Goerigk S, Gomes JS, Brem AK, Carvalho JB, Pinto BS, Elkis H, Gattaz WF, Padberg F, Brunoni AR, Valiengo L. Cognitive outcomes after tDCS in schizophrenia patients with prominent negative symptoms: Results from the placebo-controlled STARTS trial. Schizophr Res 2021; 235:44-51. [PMID: 34304146 DOI: 10.1016/j.schres.2021.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/16/2022]
Abstract
Cognitive deficits and negative symptoms in schizophrenia are associated with poor functional outcomes and limited in terms of treatment. The Schizophrenia Treatment With Electric Transcranial Stimulation (STARTS) trial has shown efficacy of transcranial direct current stimulation (tDCS) for improving negative symptoms. In this secondary analysis, we investigate its effects on cognitive performance. In STARTS, a double-blinded, sham-controlled, randomized clinical trial, patients were treated with twice-daily, 20-min, 2-mA fronto-temporal tDCS over 5 days or sham-tDCS. In 90 patients, we evaluated the cognitive performance up to 12 weeks post-treatment. We found that active-tDCS showed no beneficial effects over sham-tDCS in any of the tests. Based on a 5-factor cognitive model, improvements of executive functions and delayed memory were observed in favor of sham-tDCS. Overall, the applied active-tDCS protocol, primarily designed to improve negative symptoms, did not promote cognitive improvement. We discuss possible protocol modification potentially required to increase tDCS effects on cognition. ClinicalTrials.gov identifier: NCT02535676.
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Affiliation(s)
- Lucia Bulubas
- Department of Psychiatry and Psychotherapy, LMU Hospital, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, LMU Hospital, Munich, Germany; Department of Psychological Methodology and Assessment, LMU, Munich, Germany; Hochschule Fresenius, University of Applied Sciences, Munich, Germany
| | - July S Gomes
- Schizophrenia Program, Dep. of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Anna-Katharine Brem
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland; Department of Neuropsychology, Lucerne Psychiatry, Switzerland; Division of Interventional Cognitive Neurology, Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Juliana B Carvalho
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bianca S Pinto
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Helio Elkis
- Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Wagner F Gattaz
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, LMU Hospital, Munich, Germany
| | - Andre R Brunoni
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Leandro Valiengo
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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6
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Aryutova K, Paunova R, Kandilarova S, Todeva-Radneva A, Stoyanov D. Implications from translational cross-validation of clinical assessment tools for diagnosis and treatment in psychiatry. World J Psychiatry 2021; 11:169-180. [PMID: 34046313 PMCID: PMC8134869 DOI: 10.5498/wjp.v11.i5.169] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/17/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023] Open
Abstract
Traditional therapeutic methods in psychiatry, such as psychopharmacology and psychotherapy help many people suffering from mental disorders, but in the long-term prove to be effective in a relatively small proportion of those affected. Therapeutically, resistant forms of mental disorders such as schizophrenia, major depressive disorder, and bipolar disorder lead to persistent distress and dysfunction in personal, social, and professional aspects. In an effort to address these problems, the translational approach in neuroscience has initiated the inclusion of novel or modified unconventional diagnostic and therapeutic techniques with promising results. For instance, neuroimaging data sets from multiple modalities provide insight into the nature of pathophysiological mechanisms such as disruptions of connectivity, integration, and segregation of neural networks, focusing on the treatment of mental disorders through instrumental biomedical methods such as electro-convulsive therapy (ECT), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS). These methodologies have yielded promising results that have yet to be understood and improved to enhance the prognosis of the severe and persistent psychotic and affective disorders. The current review is focused on the translational approach in the management of schizophrenia and mood disorders, as well as the adaptation of new transdisciplinary diagnostic tools such as neuroimaging with concurrently administered psychopathological questionnaires and integration of the results into the therapeutic framework using various advanced instrumental biomedical tools such as ECT, TMS, tDCS and DBS.
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Affiliation(s)
- Katrin Aryutova
- Department of Psychiatry and Medical Psychology, Scientific Research Institute, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
| | - Rositsa Paunova
- Department of Psychiatry and Medical Psychology, Scientific Research Institute, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
| | - Sevdalina Kandilarova
- Department of Psychiatry and Medical Psychology, Scientific Research Institute, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
| | - Anna Todeva-Radneva
- Department of Psychiatry and Medical Psychology, Scientific Research Institute, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
| | - Drozdstoy Stoyanov
- Department of Psychiatry and Medical Psychology, Scientific Research Institute, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
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Gupta T, Mittal VA. Transcranial direct current stimulation and emotion processing deficits in psychosis and depression. Eur Arch Psychiatry Clin Neurosci 2021; 271:69-84. [PMID: 32488523 PMCID: PMC7704557 DOI: 10.1007/s00406-020-01146-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/23/2020] [Indexed: 01/11/2023]
Abstract
Emotional processing deficits (EPDs) are commonly observed among individuals diagnosed with (1) psychotic disorders (2) and depression. Given that EPDs can impact overall functioning and quality of life, the need to identify effective interventions is critical. To date, our current understanding of treatments for these impairments is limited. However, there is increasing interest in investigating the efficacy of transcranial direct current stimulation (tDCS). This neuromodulation technique releases a weak electrical current through the brain. Given research suggesting promise for using tDCS to improve symptoms and cognition across psychopathology, this approach may be useful for improving EPDs and related symptoms in psychosis and depression. In the current review, we provide an overview of the literature determining the effects of tDCS for EPDs and related symptoms in these groups. Furthermore, we highlight methodological advances and pinpoint potential future directions.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL, 60208, USA.
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL, 60208, USA
- Department of Psychiatry, Northwestern University, Chicago, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
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8
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Haller N, Hasan A, Padberg F, Strube W, da Costa Lane Valiengo L, Brunoni AR, Brunelin J, Palm U. [Transcranial electrical brain stimulation methods for treatment of negative symptoms in schizophrenia]. DER NERVENARZT 2021; 93:41-50. [PMID: 33492411 PMCID: PMC8763819 DOI: 10.1007/s00115-021-01065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/24/2022]
Abstract
Über die letzten Jahre entwickelten sich Neuromodulationsverfahren zu einer dritten Säule neben Pharmakotherapie und Psychotherapie in der Behandlung psychischer Erkrankungen. Besonders in der Behandlung von Menschen mit einer Schizophrenie könnten Hirnstimulationsverfahren eine Alternative oder Ergänzung zu den etablierten Therapiestrategien darstellen. Die meist vorhandenen Positivsymptome können zumeist mit Antipsychotika adäquat behandelt werden. Gerade bei Patienten mit Schizophrenie besitzen jedoch Negativsymptome einen überdauernden Krankheitswert und beeinflussen den Verlauf durch globale Antriebsverarmung und beeinträchtigte Kognition im alltäglichen Leben negativ. Dieser Übersichtsartikel stellt eine Zusammenfassung über die verschiedenen nichtinvasiven Hirnstimulationsverfahren transkranielle Gleichstromstimulation (transcranial direct current stimulation, tDCS), Wechselstromstimulation (transcranial alternating current stimulation, tACS) sowie Rauschstromstimulation (transcranial random noise stimulation, tRNS) zur Behandlung der Negativsymptomatik bei Schizophrenie dar. Die neuen transkraniellen Hirnstimulationsverfahren könnten dabei helfen, gestörte neuronale Vernetzungen wieder herzustellen und die Konnektivität vor allem der dorsolateralen präfrontalen Anteile des Kortex zu verbessern. Einige Studien weisen auf eine Verbesserung der Negativsymptome durch Behandlung mit tDCS, tACS bzw. tRNS hin und könnten so neue Therapiemöglichkeiten in der Behandlung der Schizophrenie darstellen.
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Affiliation(s)
- Nikolas Haller
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Alkomiet Hasan
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland.,Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universität Augsburg, Medizinische Fakultät, BKH Augsburg, Augsburg, Deutschland
| | - Frank Padberg
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Wolfgang Strube
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universität Augsburg, Medizinische Fakultät, BKH Augsburg, Augsburg, Deutschland
| | - Leandro da Costa Lane Valiengo
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasilien
| | - Andre R Brunoni
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasilien
| | - Jerome Brunelin
- CH le Vinatier, INSERM U 1028, CNRS UMR 5292, PSYR2 Team, Centre de recherche en neuroscience de Lyon, Université de Lyon, Lyon, Frankreich
| | - Ulrich Palm
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland. .,Medical Park Chiemseeblick, Rasthausstr. 25, 83233, Bernau-Felden, Deutschland.
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9
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Jahshan C, Wynn JK, Roach BJ, Mathalon DH, Green MF. Effects of Transcranial Direct Current Stimulation on Visual Neuroplasticity in Schizophrenia. Clin EEG Neurosci 2020; 51:382-389. [PMID: 32463701 DOI: 10.1177/1550059420925697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
People with schizophrenia (SZ) exhibit visual processing abnormalities that affect their daily functioning and remediating these deficits might help to improve functioning. Transcranial direct current stimulation (tDCS) is a potential tool for perceptual enhancement for this purpose, though there are no reports of tDCS applied to visual cortex in SZ. In a within-subject, crossover design, we evaluated the effects of tDCS on visual processing in 27 SZ. All patients received anodal, cathodal, or sham stimulation over the central occipital region in 3 visits separated by 1 week. In each visit, a backward masking task and an electroencephalography measure of visual neuroplasticity were administered after tDCS. Neuroplasticity was assessed with visual evoked potentials before and after tetanizing visual high-frequency stimulation. Masking performance was significantly poorer in the anodal and cathodal conditions compared with sham. Both anodal and cathodal stimulation increased the amplitude of P1 but did not change the plasticity index. We found significant plasticity effects of tDCS for only one waveform for one stimulation condition (P2 for anodal tDCS) which did not survive correction for multiple comparisons. The reason for the lack of tDCS stimulation effects on plasticity may be because tDCS was not delivered simultaneously with the tetanizing visual stimulus. The present findings emphasize the need for more research on the relevant parameters for stimulation of visual processing regions in clinical populations.
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Affiliation(s)
- Carol Jahshan
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Jonathan K Wynn
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Brian J Roach
- San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA, USA.,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Daniel H Mathalon
- San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA, USA.,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Michael F Green
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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10
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Boudewyn MA, Scangos K, Ranganath C, Carter CS. Using prefrontal transcranial direct current stimulation (tDCS) to enhance proactive cognitive control in schizophrenia. Neuropsychopharmacology 2020; 45:1877-1883. [PMID: 32604401 PMCID: PMC7608454 DOI: 10.1038/s41386-020-0750-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 11/09/2022]
Abstract
The goal of this study was to use transcranial direct current stimulation (tDCS) to examine the role of the prefrontal cortex (PFC) in neural oscillatory activity associated with proactive cognitive control in schizophrenia. To do so, we tested the impact of PFC-targeted tDCS on behavioral and electrophysiological markers of proactive cognitive control engagement in individuals with schizophrenia. Using a within-participants, double-blinded, sham-controlled crossover design, we recorded EEG while participants with schizophrenia completed a proactive cognitive control task (the Dot Pattern Expectancy (DPX) Task), after receiving 20 min of active prefrontal stimulation at 2 mA or sham stimulation. We hypothesized that active stimulation would enhance proactive cognitive control, leading to changes in behavioral performance on the DPX task and in activity in the gamma frequency band during key periods of the task designed to tax proactive cognitive control. The results showed significant changes in the pattern of error rates and increases in EEG gamma power as a function of tDCS condition (active or sham), that were indicative of enhanced proactive cognitive control. These findings, considered alongside our previous work in healthy adults, provides novel support for the role gamma oscillations in proactive cognitive control and they suggest that frontal tDCS may be a promising approach to enhance proactive cognitive control in schizophrenia.
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Affiliation(s)
- Megan A. Boudewyn
- grid.205975.c0000 0001 0740 6917University of California, Santa Cruz, CA USA
| | - Katherine Scangos
- grid.266102.10000 0001 2297 6811University of California, San Francisco, CA USA
| | - Charan Ranganath
- grid.27860.3b0000 0004 1936 9684University of California, Davis, CA USA
| | - Cameron S. Carter
- grid.27860.3b0000 0004 1936 9684University of California, Davis, CA USA
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Ciullo V, Spalletta G, Caltagirone C, Banaj N, Vecchio D, Piras F, Piras F. Transcranial Direct Current Stimulation and Cognition in Neuropsychiatric Disorders: Systematic Review of the Evidence and Future Directions. Neuroscientist 2020; 27:285-309. [PMID: 32644874 DOI: 10.1177/1073858420936167] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been implemented in neuropsychiatric disorders characterized by cognitive impairment. However, methodological heterogeneity challenges conclusive remarks. Through a critical analysis of previous conflicting findings and in the light of current neurobiological models of pathophysiology, we qualitatively assessed the effects of tDCS in neuropsychiatric disorders that share neurobiological underpinnings, as to evaluate whether stimulation can improve cognitive deficits in patients' cohorts. We performed a systematic review of tDCS studies targeting cognitive functions in mental disorders and pathological cognitive aging. Data from 41 studies, comprising patients with diagnosis of mood disorders, schizophrenia-spectrum disorders, Alzheimer's disease (AD), and mild cognitive impairment (MCI), were included. Results indicate that tDCS has the capacity to enhance processing speed, working memory, and executive functions in patients with mood and schizophrenia-spectrum disorders. The evidence of a positive effect on general cognitive functioning and memory is either inconclusive in AD, or weak in MCI. Future directions are discussed for developing standardized stimulation protocols and for translating the technique therapeutic potential into effective clinical practice.
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Affiliation(s)
- Valentina Ciullo
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Gianfranco Spalletta
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Carlo Caltagirone
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Nerisa Banaj
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Daniela Vecchio
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Fabrizio Piras
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Federica Piras
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
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12
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Kostova R, Cecere R, Thut G, Uhlhaas PJ. Targeting cognition in schizophrenia through transcranial direct current stimulation: A systematic review and perspective. Schizophr Res 2020; 220:300-310. [PMID: 32204971 DOI: 10.1016/j.schres.2020.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 01/03/2023]
Abstract
Cognitive deficits are a fundamental feature of schizophrenia for which currently no effective treatments exist. This paper examines the possibility to use transcranial direct current stimulation (tDCS) to target cognitive deficits in schizophrenia as evidence from studies in healthy participants suggests that tDCS may improve cognitive functions and associated neural processes. We carried out a systematic review with the following search terms: 'tDCS', 'electric brain stimulation', 'schizophrenia', 'cognitive', 'cognition' until March 2019. 659 records were identified initially, 612 of which were excluded after abstract screening. The remaining 47 articles were assessed for eligibility based on our criteria and 26 studies were excluded. In addition, we compared several variables, such as online vs. offline-stimulation protocols, stimulation type and intensity on mediating positive vs. negative study outcomes. The majority of studies (n = 21) identified significant behavioural and neural effects on a range of cognitive functions (versus n = 11 with null results), including working memory, attention and social cognition. However, we could not identify tDCS parameters (electrode montage, stimulation protocol, type and intensity) that clearly mediated effects on cognitive deficits. There is preliminary evidence for the possibility that tDCS may improve cognitive deficits in schizophrenia. We discuss the rationale and strength of evidence for using tDCS for targeting cognitive deficits in schizophrenia as well as methodological issues and potential mechanisms of action.
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Affiliation(s)
- R Kostova
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - R Cecere
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - G Thut
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK; Department of Child and Adolescent Psychiatry, Charite Universitätsmedizin Berlin, Berlin, Germany.
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13
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Transcranial direct current stimulation: a roadmap for research, from mechanism of action to clinical implementation. Mol Psychiatry 2020; 25:397-407. [PMID: 31455860 PMCID: PMC6981019 DOI: 10.1038/s41380-019-0499-9] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/27/2019] [Accepted: 07/09/2019] [Indexed: 01/24/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a promising method for altering the function of neural systems, cognition, and behavior. Evidence is emerging that it can also influence psychiatric symptomatology, including major depression and schizophrenia. However, there are many open questions regarding how the method might have such an effect, and uncertainties surrounding its influence on neural activity, and human cognition and functioning. In the present critical review, we identify key priorities for future research into major depression and schizophrenia, including studies of the mechanism(s) of action of tDCS at the neuronal and systems levels, the establishment of the cognitive impact of tDCS, as well as investigations of the potential clinical efficacy of tDCS. We highlight areas of progress in each of these domains, including data that appear to favor an effect of tDCS on neural oscillations rather than spiking, and findings that tDCS administration to the prefrontal cortex during task training may be an effective way to enhance behavioral performance. Finally, we provide suggestions for further empirical study that will elucidate the impact of tDCS on brain and behavior, and may pave the way for efficacious clinical treatments for psychiatric disorders.
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14
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Chang CC, Kao YC, Chao CY, Tzeng NS, Chang HA. Examining bi-anodal transcranial direct current stimulation (tDCS) over bilateral dorsolateral prefrontal cortex coupled with bilateral extracephalic references as a treatment for negative symptoms in non-acute schizophrenia patients: A randomized, double-blind, sham-controlled trial. Prog Neuropsychopharmacol Biol Psychiatry 2020; 96:109715. [PMID: 31362034 DOI: 10.1016/j.pnpbp.2019.109715] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/05/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022]
Abstract
No studies have examined the efficacy of bi-anodal transcranial direct current stimulation (tDCS) over bilateral dorsolateral prefrontal cortex (DLPFC) coupled with bilateral extracephalic references in treating negative symptoms of non-acute schizophrenia patients. This study aimed to investigate the therapeutic effects of the new approach of tDCS on negative symptoms, other schizophrenia symptoms, cognitive deficits and psychosocial functioning in a double-blind, randomized, sham-controlled trial. Patients with non-acute schizophrenia (N = 60) in randomized order received sham treatment or bilaterally provided tDCS (2 mA, twice-daily sessions for five consecutive days) with the anode over the DLPFC and the reference (cathode) over the ipsilateral forearm. The negative symptoms as measured by a dimensional approach of Positive and Negative Syndrome Scale (PANSS) were rapidly reduced by bimodal tDCS relative to sham stimulation (F = 24.86, Cohen's d = 0.661, p = 6.11 × 10-6). The beneficial effect on negative symptoms lasted for up to 3 months. The authors also observed improvement with tDCS of psychosocial functioning as measured by the global score of Personal and Social Performance scale (PSP) and psychopathological symptoms especially for disorganization and cognitive symptoms as measured by the PANSS. No effects were observed on other schizophrenia symptom dimensions and the performance on a series of neurocognitive tests. Our results show promise for bi-anodal tDCS over bilateral DLPFC using bilateral extracephalic references in treating negative symptoms and other selected manifestations of schizophrenia. Further studies with electrophysiological or imaging evaluation help unravel the exact mechanism of action of this novel stimulation parameter of tDCS in schizophrenia patients. (ClinicalTrials.gov ID:NCT03701100).
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Affiliation(s)
- Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Che-Yi Chao
- Department of Psychiatry, Cardinal Tien Hospital, New Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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15
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Weickert TW, Salimuddin H, Lenroot RK, Bruggemann J, Loo C, Vercammen A, Kindler J, Weickert CS. Preliminary findings of four-week, task-based anodal prefrontal cortex transcranial direct current stimulation transferring to other cognitive improvements in schizophrenia. Psychiatry Res 2019; 280:112487. [PMID: 31376788 DOI: 10.1016/j.psychres.2019.112487] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023]
Abstract
Most transcranial Direct Current Stimulation (tDCS) trials of schizophrenia administer few sessions and do not assess transfer effects to other cognitive domains. In a randomized, double-blind, sham-controlled, parallel groups trial, we determined the extent to which 4-weeks of 2 mA tDCS at 20 min/day totalling 20 tDCS sessions administered during a spatial working memory test, with anodal right dorsolateral prefrontal cortex (DLPFC) and cathodal left tempo-parietal junction (TPJ) placement, as an adjunct to antipsychotics reduced auditory hallucinations and improved cognition in 12 outpatients with schizophrenia. Anodal tDCS significantly improved language-based working memory after 2 weeks and verbal fluency after 2 and 4 weeks. Thus, four weeks of tDCS appears to be safe and elicits transfer benefits to other prefrontal-dependent cognitive abilities in schizophrenia.
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Affiliation(s)
- T W Weickert
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia.
| | - H Salimuddin
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - R K Lenroot
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, USA
| | - J Bruggemann
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia
| | - C Loo
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - A Vercammen
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; Faculty of Natural Sciences, Imperial College London, London, UK
| | - J Kindler
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - C S Weickert
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia
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Kim J, Plitman E, Nakajima S, Alshehri Y, Iwata Y, Chung JK, Caravaggio F, Menon M, Blumberger DM, Pollock BG, Remington G, De Luca V, Graff-Guerrero A, Gerretsen P. Modulation of brain activity with transcranial direct current stimulation: Targeting regions implicated in impaired illness awareness in schizophrenia. Eur Psychiatry 2019; 61:63-71. [DOI: 10.1016/j.eurpsy.2019.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/15/2019] [Accepted: 06/21/2019] [Indexed: 01/29/2023] Open
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Chang CC, Kao YC, Chao CY, Chang HA. Enhancement of cognitive insight and higher-order neurocognitive function by fronto-temporal transcranial direct current stimulation (tDCS) in patients with schizophrenia. Schizophr Res 2019; 208:430-438. [PMID: 30635256 DOI: 10.1016/j.schres.2018.12.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/30/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Abstract
No studies have examined the effects of fronto-temporal transcranial direct current stimulation (tDCS) on cognitive insight and neurocognitive function in schizophrenia patients and the dynamic interplay between tDCS-induced changes in these two outcomes. In this double-blind, randomized, sham-controlled study, we investigated the effects of fronto-temporal tDCS [anode corresponding to left dorsolateral prefrontal cortex and cathode to left temporo-parietal junction; 2-mA, twice-daily sessions for 5 days] on illness severity, psychosocial functioning, cognitive insight and neurocognitive function in schizophrenia patients (N = 60). The authors observed significant trends that tDCS ameliorated the severity of total and general psychopathology as measured by the Positive and Negative Syndrome Scale. No significant effects were observed for other psychopathological symptoms and psychosocial functioning. Cognitive insight as measured by the Beck Cognitive Insight Scale (BCIS) was rapidly enhanced by 10-session tDCS (F = 10.80, Cohen's d = 0.44, p = 0.002) but the beneficial effect became borderline significant 1 month after stimulation. A trend-level improvement with tDCS of planning ability (F = 6.40, Cohen's d = 0.339, p = 0.014) as measured by the accuracy in Tower of London task was also observed. In the active tDCS group, the change in cognitive insight from baseline to immediately after tDCS assessment was positively correlated with that in planning ability (r = 0.46, p = 0.015), which was independent of the corresponding change in illness severity. The promising results regarding the fast-acting beneficial effects of tDCS on cognitive insight and planning ability in schizophrenia require confirmation in future replication studies.
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Affiliation(s)
- Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Che-Yi Chao
- Department of Psychiatry, Cardinal Tien Hospital, New Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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18
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Lindenmayer JP, Kulsa MKC, Sultana T, Kaur A, Yang R, Ljuri I, Parker B, Khan A. Transcranial direct-current stimulation in ultra-treatment-resistant schizophrenia. Brain Stimul 2018; 12:54-61. [PMID: 30316742 DOI: 10.1016/j.brs.2018.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Transcranial direct-current stimulation (tDCS), a non-invasive neurostimulation treatment, has been reported in a number of sham-controlled studies to show significant improvements in treatment-resistant auditory hallucinations in schizophrenia patients, primarily in ambulatory and higher-functioning patients, but little is known of the effects of tDCS on hospitalized, low-functioning inpatients. OBJECTIVE/HYPOTHESIS The purpose of this study was to examine the efficacy and safety of tDCS for auditory hallucinations in hospitalized ultra-treatment-resistant schizophrenia (TRS) and to evaluate the effects of tDCS on cognitive functions. We hypothesized that treatment non-response reported in previous tDCS studies may have been due to the insufficient duration of direct-current stimulation. METHODS Inpatient participants with DSM-V schizophrenia, long-standing treatment-resistance, and auditory verbal hallucinations (AVH) participated in this 4-week sham-controlled, randomized trial. Assessments included the Positive and Negative Syndrome Scale (PANSS) and MATRICS Consensus Cognitive Battery (MCCB) at baseline and endpoint (at the end of Week 4), and the Auditory Hallucinations Rating Scale (AHRS) administered at baseline, endpoint, and weekly throughout the study. Participants were randomized to receive active vs. sham tDCS treatments twice daily for 4 weeks. RESULTS Twenty-eight participants were enrolled (tDCS, n = 15; control, n = 13) and 21 participants completed all 4 weeks of the trial. Results showed a significant reduction for the auditory hallucination total score (p ≤ 0.05). We found a 21.9% decrease in AHRS Total Score for the tDCS group and a 12.6% decrease in AHRS Total Score for the control group. Significant reductions in frequency, number of voices over time, length of auditory hallucinations, and overall psychopathology were also observed for the tDCS group. When assessing cognitive functioning, only Working Memory showed improvement for the tDCS group. CONCLUSION Although there was only a small improvement noted in auditory hallucination scores for the tDCS group, this improvement was meaningful when compared to no standard treatment of the control group. While this makes the interpretation of clinical significance debatable, it does confirm that tDCS combined with pharmacological intervention can provide clinical gains over pharmacological intervention alone. Therefore, tDCS treatment appears to be effective not only for ambulatory, higher-functioning patients, but also for patients with ultra-treatment-resistant schizophrenia.
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Affiliation(s)
- J P Lindenmayer
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA; New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Mila Kirstie C Kulsa
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA; Teachers College Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
| | - Tania Sultana
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA.
| | - Amandeep Kaur
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA.
| | - Ran Yang
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA; Teachers College Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
| | - Isidora Ljuri
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA.
| | - Benedicto Parker
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA.
| | - Anzalee Khan
- Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA; NeuroCog Trials, 3211 Shannon Road #300, Durham, NC, 27707, USA.
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Gupta T, Dean DJ, Kelley NJ, Bernard JA, Ristanovic I, Mittal VA. Cerebellar Transcranial Direct Current Stimulation Improves Procedural Learning in Nonclinical Psychosis: A Double-Blind Crossover Study. Schizophr Bull 2018; 44:1373-1380. [PMID: 29301026 PMCID: PMC6192475 DOI: 10.1093/schbul/sbx179] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The present double-blind crossover study examines the effects of cerebellar transcranial direct current stimulation (tDCS) in controls and in an analogue population to psychosis: individuals reporting elevated symptoms of nonclinical psychosis (NCP). A total of 18 controls and 24 NCP individuals were randomized into conditions consisting of 25 minutes of anodal (active) or sham cerebellar tDCS. Following this, both groups completed a pursuit rotor task designed to measure procedural learning performance. Participants then returned 1-week later and received the corresponding condition (either active or sham) and repeated the pursuit rotor task. Results indicate that in the sham condition, control participants showed significantly greater rates of motor learning when compared with the NCP group. In the active condition, the NCP group exhibited significant improvements in the rate of motor learning and performed at a level that was comparable to controls; these data support the link between cerebellar dysfunction and motor learning. Taken together, tDCS may be a promising treatment mechanism for patient populations and a useful experimental approach in elucidating our understanding of psychosis.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL,To whom correspondence should be addressed; Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208, US; tel: 847-467-5907, fax: 847-467-5707, e-mail:
| | - Derek J Dean
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO,Center for Neuroscience, University of Colorado Boulder, Boulder, CO
| | | | - Jessica A Bernard
- Department of Psychology, Texas A&M University, College Station, TX,Institute for Neuroscience, Texas A&M University, College Station, TX
| | | | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL,Department of Psychiatry, Northwestern University, Evanston, ILs,Institute of Policy Research, Northwestern University, Evanston, IL,Department of Medical Social Sciences, Northwestern University, Evanston, IL,Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
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20
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Mehta UM. Roadblocks to driving cognitive gains through transcranial electrical stimulation. Schizophr Res 2018; 199:44-45. [PMID: 29669695 PMCID: PMC7610503 DOI: 10.1016/j.schres.2018.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Urvakhsh Meherwan Mehta
- Assistant Professor of Psychiatry & Wellcome Trust/DBT India Alliance Early Career Fellow, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
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Abstract
Transcranial direct current stimulation (tDCS) is a neuromodulatory approach that is affordable, safe, and well tolerated. This review article summarizes the research and clinically relevant findings from meta-analyses and studies investigating the cognitive effects of tDCS in healthy and clinical populations. We recapitulate findings from recent studies where cognitive performance paired with tDCS was compared with performance under placebo (sham stimulation) in single sessions and longitudinal designs where cognitive effects were evaluated following repeated sessions. In summary, the tDCS literature currently indicates that the effects of tDCS on cognitive measures are less robust and less predictable compared with the more consistent effects on motor outcomes. There is also a notable difference in the consistency of single-session and longitudinal designs. In single-session tDCS designs, there are small effects amid high variability confounded by individual differences and potential sham stimulation effects. In contrast, longitudinal studies provide more consistent benefits in healthy and clinical populations, particularly when tDCS is paired with a concurrent task. Yet, these studies are few in number, thereby impeding design optimization. While there is good evidence that tDCS can modulate cognitive functioning and potentially produce longer-term benefits, a major challenge to widespread translation of tDCS is the absence of a complete mechanistic account for observed effects. Significant future work is needed to identify a priori responders from nonresponders for every cognitive task and tDCS protocol.
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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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Gupta T, Kelley NJ, Pelletier-Baldelli A, Mittal VA. Transcranial Direct Current Stimulation, Symptomatology, and Cognition in Psychosis: A Qualitative Review. Front Behav Neurosci 2018; 12:94. [PMID: 29892215 PMCID: PMC5985327 DOI: 10.3389/fnbeh.2018.00094] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/23/2018] [Indexed: 12/22/2022] Open
Abstract
Schizophrenia is a chronic, debilitating condition that affects approximately 1% of the population. Individuals diagnosed with schizophrenia typically exhibit positive (e.g., hallucinations) and negative symptoms (e.g., anhedonia) and impairments in cognitive function. Given the limitations of antipsychotic medication and psychotherapy in fully treating psychosis symptomatology, there has been increasing interest in other interventions such as transcranial direct current stimulation (tDCS). tDCS is a non-invasive neuromodulation technique, that is safe, cost-effective, and widely accessible. Here, we discuss treatment studies that seek to improve symptoms and cognitive performance in schizophrenia using tDCS. Currently within the literature, there is support for reductions in positive symptoms such as hallucinations after receiving tDCS. Further, studies indicate that tDCS can improve cognitive functioning, which is an area of investigation that is sorely needed, as it is unclear which types of interventions may be useful in ameliorating cognitive deficits among this group. Taken together, the evidence suggests that tDCS holds promise in improving symptoms and cognition. To that end, tDCS has critical clinical implications for this population.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Nicholas J Kelley
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Andrea Pelletier-Baldelli
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, United States.,Department of Psychiatry, Northwestern University, Chicago, IL, United States.,Institute for Policy Research, Northwestern University, Evanston, IL, United States.,Medical Social Sciences, Northwestern University, Chicago, IL, United States.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States
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Rassovsky Y, Dunn W, Wynn JK, Wu AD, Iacoboni M, Hellemann G, Green MF. Single transcranial direct current stimulation in schizophrenia: Randomized, cross-over study of neurocognition, social cognition, ERPs, and side effects. PLoS One 2018; 13:e0197023. [PMID: 29734347 PMCID: PMC5937783 DOI: 10.1371/journal.pone.0197023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 04/13/2018] [Indexed: 11/18/2022] Open
Abstract
Over the last decades, the treatment of schizophrenia has shifted fundamentally from a focus on symptom reduction to a focus on recovery and improving aspects of functioning. In this study, we examined the effect of transcranial direct current stimulation (tDCS) on social cognitive and nonsocial neurocognitive functions, as well as on electroencephalogram (EEG) measures, in individuals with schizophrenia. Thirty-seven individuals with schizophrenia were administered one of three different tDCS conditions (cathodal, anodal, and sham) per visit over the course of three visits, with approximately one week between each visit. Order of conditions was randomized and counterbalanced across subjects. For the active conditions, the electrode was placed over the left dorsolateral prefrontal cortex with the reference electrode over right supraorbital cortex. Current intensity was 2 mA and was maintained for two 20-minute sessions, with a one hour break between the sessions. Assessments were conducted immediately following each session, in a counterbalanced order of administration. No systematic effects were found across the social and nonsocial cognitive domains, and no significant effects were detected on event-related potentials (ERPs). The very small effect sizes, further validated by post-hoc power analyses (large Critical Ns), demonstrated that these findings were not due to lack of statistical power. Except for mild local discomfort, no significant side effects were reported. Findings demonstrate the safety and ease of administration of this procedure, but suggest that a single dose of tDCS over these areas does not yield a therapeutic effect on cognition in schizophrenia. Trial registration: ClinicalTrials.gov NCT02539797.
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Affiliation(s)
- Yuri Rassovsky
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States of America
- * E-mail:
| | - Walter Dunn
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States of America
- Department of Veteran Affairs VISN-22 Mental Illness Research, Education and Clinical Center, Los Angeles, CA, United States of America
| | - Jonathan K. Wynn
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States of America
- Department of Veteran Affairs VISN-22 Mental Illness Research, Education and Clinical Center, Los Angeles, CA, United States of America
| | - Allan D. Wu
- Department of Neurology, University of California, Los Angeles, California, United States of America
| | - Marco Iacoboni
- Department of Neurology, University of California, Los Angeles, California, United States of America
- Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, California, United States of America
| | - Gerhard Hellemann
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Michael F. Green
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States of America
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Martin DM, Moffa A, Nikolin S, Bennabi D, Brunoni AR, Flannery W, Haffen E, McClintock SM, Moreno ML, Padberg F, Palm U, Loo CK. Cognitive effects of transcranial direct current stimulation treatment in patients with major depressive disorder: An individual patient data meta-analysis of randomised, sham-controlled trials. Neurosci Biobehav Rev 2018; 90:137-145. [PMID: 29660416 DOI: 10.1016/j.neubiorev.2018.04.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/21/2018] [Accepted: 04/09/2018] [Indexed: 01/24/2023]
Abstract
Transcranial direct current stimulation (tDCS) has emerged as a promising new treatment for major depression. While recent randomised, sham-controlled studies found tDCS to have antidepressant effects, it remains to be determined whether a tDCS treatment course may also enhance cognitive function independent of mood effects in depressed patients. This systematic review and individual patient data (IPD) meta-analysis examined cognitive outcomes from randomised, sham-controlled trials of tDCS treatment for major depression. Seven randomised, sham-controlled trials (n = 478 participants, 260 in active and 218 in sham) of tDCS for major depression were included. Results showed no cognitive enhancement after active tDCS compared to sham for the 12 cognitive outcomes investigated. Active relative to sham tDCS treatment was associated with reduced performance gains on a measure of processing speed (β = -0.33, 95% CI -0.58; -0.08, p = 0.011). Active tDCS treatment for depression did not show cognitive benefits independent of mood effects. Rather, tDCS treatment relative to sham stimulation for major depression may instead be associated with a reduced practice effect for processing speed.
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Affiliation(s)
- Donel M Martin
- School of Psychiatry, Black Dog Institute, University of New South Wales, Hospital Rd., Randwick, Sydney NSW 2031, Australia.
| | - Adriano Moffa
- School of Psychiatry, Black Dog Institute, University of New South Wales, Hospital Rd., Randwick, Sydney NSW 2031, Australia
| | - Stevan Nikolin
- School of Psychiatry, Black Dog Institute, University of New South Wales, Hospital Rd., Randwick, Sydney NSW 2031, Australia
| | - Djamila Bennabi
- Department of Clinical Psychiatry, Clinical Investigation Center 1431 Inserm, EA 481 Neurosciences, University Hospital of Besancon and FondaMental Foundation, Créteil, France
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - William Flannery
- School of Psychiatry, Black Dog Institute, University of New South Wales, Hospital Rd., Randwick, Sydney NSW 2031, Australia
| | - Emmanuel Haffen
- Department of Clinical Psychiatry, Clinical Investigation Center 1431 Inserm, EA 481 Neurosciences, University Hospital of Besancon and FondaMental Foundation, Créteil, France
| | - Shawn M McClintock
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Marina L Moreno
- Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
| | - Colleen K Loo
- School of Psychiatry, Black Dog Institute, University of New South Wales, Hospital Rd., Randwick, Sydney NSW 2031, Australia
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Effects of transcranial direct current stimulation on the auditory mismatch negativity response and working memory performance in schizophrenia: a pilot study. J Neural Transm (Vienna) 2017; 124:1489-1501. [PMID: 28864916 DOI: 10.1007/s00702-017-1783-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: 05/22/2017] [Accepted: 08/21/2017] [Indexed: 01/06/2023]
Abstract
Cognitive impairment has been proposed to be the core feature of schizophrenia (Sz). Transcranial direct current stimulation (tDCS) is a non-invasive form of brain stimulation which can improve cognitive function in healthy participants and in psychiatric patients with cognitive deficits. tDCS has been shown to improve cognition and hallucination symptoms in Sz, a disorder also associated with marked sensory processing deficits. Recent findings in healthy controls demonstrate that anodal tDCS increases auditory deviance detection, as measured by the brain-based event-related potential, mismatch negativity (MMN), which is a putative biomarker of Sz that has been proposed as a target for treatment of Sz cognition. This pilot study conducted a randomized, double-blind assessment of the effects of pre- and post-tDCS on MMN-indexed auditory discrimination in 12 Sz patients, moderated by auditory hallucination (AH) presence, as well as working memory performance. Assessments were conducted in three sessions involving temporal and frontal lobe anodal stimulation (to transiently excite local brain activity), and one control session involving 'sham' stimulation (meaning with the device turned off, i.e., no stimulation). Results demonstrated a trend for pitch MMN amplitude to increase with anodal temporal tDCS, which was significant in a subgroup of Sz individuals with AHs. Anodal frontal tDCS significantly increased WM performance on the 2-back task, which was found to positively correlate with MMN-tDCS effects. The findings contribute to our understanding of tDCS effects for sensory processing deficits and working memory performance in Sz and may have implications for psychiatric disorders with sensory deficits.
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Magdaleno-Madrigal VM, Contreras-Murillo G, Camacho-Abrego I, Negrete-Díaz JV, Valdés-Cruz A, Fernández-Mas R, Almazán-Alvarado S, Flores G. Short-term deep brain stimulation of the thalamic reticular nucleus modifies aberrant oscillatory activity in a neurodevelopment model of schizophrenia. Neuroscience 2017; 357:99-109. [DOI: 10.1016/j.neuroscience.2017.05.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/08/2017] [Accepted: 05/22/2017] [Indexed: 01/13/2023]
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Orlov ND, Tracy DK, Joyce D, Patel S, Rodzinka-Pasko J, Dolan H, Hodsoll J, Collier T, Rothwell J, Shergill SS. Stimulating cognition in schizophrenia: A controlled pilot study of the effects of prefrontal transcranial direct current stimulation upon memory and learning. Brain Stimul 2017; 10:560-566. [DOI: 10.1016/j.brs.2016.12.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/07/2016] [Accepted: 12/23/2016] [Indexed: 12/20/2022] Open
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Abstract
Neuroplasticity represents the dynamic structural and functional reorganization of the central nervous system, including its connectivity, due to environmental and internal demands. It is recognized as a major physiological basis for adaption of cognition and behaviour, and, thus, of utmost importance for normal brain function. Cognitive dysfunctions are major symptoms in psychiatric disorders, which are often associated with pathological alteration of neuroplasticity. Transcranial direct current stimulation (tDCS), a recently developed non-invasive brain stimulation technique, is able to induce and modulate cortical plasticity in humans via the application of relatively weak current through the scalp of the head. It has the potential to alter pathological plasticity and restore dysfunctional cognitions in psychiatric diseases. In the last decades, its efficacy to treat psychiatric disorders has been explored increasingly. This review will give an overview of pathological alterations of plasticity in psychiatric diseases, gather clinical studies involving tDCS to ameliorate symptoms, and discuss future directions of application, with an emphasis on optimizing stimulation effects.
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Affiliation(s)
- Min-Fang Kuo
- a Department of Psychology and Neurosciences , Leibniz Research Centre for Working Environment and Human Factors , Dortmund , Germany
| | - Po-See Chen
- b Department of Psychiatry , National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan , Taiwan.,c Addiction Research Centre, National Cheng Kung University , Tainan , Taiwan
| | - Michael A Nitsche
- a Department of Psychology and Neurosciences , Leibniz Research Centre for Working Environment and Human Factors , Dortmund , Germany.,d Department of Neurology , University Medical Hospital Bergmannsheil , Bochum , Germany
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31
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A Neurophysiological Perspective on a Preventive Treatment against Schizophrenia Using Transcranial Electric Stimulation of the Corticothalamic Pathway. Brain Sci 2017; 7:brainsci7040034. [PMID: 28350371 PMCID: PMC5406691 DOI: 10.3390/brainsci7040034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/11/2017] [Accepted: 03/24/2017] [Indexed: 12/16/2022] Open
Abstract
Schizophrenia patients are waiting for a treatment free of detrimental effects. Psychotic disorders are devastating mental illnesses associated with dysfunctional brain networks. Ongoing brain network gamma frequency (30–80 Hz) oscillations, naturally implicated in integrative function, are excessively amplified during hallucinations, in at-risk mental states for psychosis and first-episode psychosis. So, gamma oscillations represent a bioelectrical marker for cerebral network disorders with prognostic and therapeutic potential. They accompany sensorimotor and cognitive deficits already present in prodromal schizophrenia. Abnormally amplified gamma oscillations are reproduced in the corticothalamic systems of healthy humans and rodents after a single systemic administration, at a psychotomimetic dose, of the glutamate N-methyl-d-aspartate receptor antagonist ketamine. These translational ketamine models of prodromal schizophrenia are thus promising to work out a preventive noninvasive treatment against first-episode psychosis and chronic schizophrenia. In the present essay, transcranial electric stimulation (TES) is considered an appropriate preventive therapeutic modality because it can influence cognitive performance and neural oscillations. Here, I highlight clinical and experimental findings showing that, together, the corticothalamic pathway, the thalamus, and the glutamatergic synaptic transmission form an etiopathophysiological backbone for schizophrenia and represent a potential therapeutic target for preventive TES of dysfunctional brain networks in at-risk mental state patients against psychotic disorders.
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32
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Mervis JE, Capizzi RJ, Boroda E, MacDonald AW. Transcranial Direct Current Stimulation over the Dorsolateral Prefrontal Cortex in Schizophrenia: A Quantitative Review of Cognitive Outcomes. Front Hum Neurosci 2017; 11:44. [PMID: 28210217 PMCID: PMC5288642 DOI: 10.3389/fnhum.2017.00044] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/20/2017] [Indexed: 11/13/2022] Open
Abstract
Cognitive deficits are a core and disabling feature of psychotic disorders, specifically schizophrenia. Current treatments for impaired cognition in schizophrenia remain insufficient. Recent research suggests transcranial direct current stimulation (tDCS) targeting the dorsolateral prefrontal cortex can potentiate cognitive improvements in healthy individuals and those with psychiatric conditions, such as schizophrenia. However, this burgeoning literature has not been quantitatively evaluated. Through a literature search and quantitative review, we identified 194 papers on tDCS, psychosis, and cognition. Selection criteria included pre/post design and sham control to achieve specific sham-adjusted effect sizes. The 6 retained studies all address schizophrenia populations and include single and repeated stimulation, as well as within and between subject designs. Small positive effects were found for anodal stimulation on behavioral measures of attention and working memory, with tentative findings for cognitive ability and memory. Cathodal stimulation yielded a small positive effect on behaviorally measured cognitive ability. Neurophysiological measures of attention showed a small to medium down-modulation effect for anodal stimulation. Implications of these findings and guidelines for future research are discussed. As revealed by this report, due to the paucity of data available, much remains unknown regarding the clinical efficacy of tDCS in schizophrenia.
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Affiliation(s)
- Joshua E Mervis
- Department of Psychology, University of Minnesota Minneapolis, MN, USA
| | - Riley J Capizzi
- Department of Psychology, University of Minnesota Minneapolis, MN, USA
| | - Elias Boroda
- Department of Neuroscience, University of Minnesota Minneapolis, MN, USA
| | - Angus W MacDonald
- Department of Psychology, University of MinnesotaMinneapolis, MN, USA; Department of Psychiatry, University of Minnesota Medical SchoolMinneapolis, MN, USA
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Narita Z, Inagawa T, Maruo K, Sueyoshi K, Sumiyoshi T. Effect of Transcranial Direct Current Stimulation on Functional Capacity in Schizophrenia: A Study Protocol for a Randomized Controlled Trial. Front Psychiatry 2017; 8:233. [PMID: 29180969 PMCID: PMC5694143 DOI: 10.3389/fpsyt.2017.00233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/31/2017] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED Schizophrenia patients elicit a wide range of psychopathology, including psychotic symptoms, mood symptoms, and cognitive impairment. Functional capacity is defined as the ability to perform everyday living skills, which is linked to cognition and real-world functional outcome. In a previous open trial, we demonstrated that transcranial direct current stimulation (tDCS), one of the neuromodulation methods, improved cognition and functional capacity in 28 patients with schizophrenia. However, since it was a pilot study, a controlled trial is needed. Therefore, we present a study protocol for a randomized controlled trial designed to evaluate the effect of tDCS on functional capacity in patients with schizophrenia. This is a two-arm, parallel-design, randomized controlled trial, in which patients and assessors will be blinded. Patients meeting DSM-5 criteria for schizophrenia will be enrolled and randomized to receive either active or sham stimulation (with 10 sessions in five consecutive days). Functional capacity will be evaluated by the UCSD Performance-based Skills Assessment-Brief as primary outcome. Cognition, as measured by the Brief Assessment of Cognition in Schizophrenia, and psychotic symptoms, as measured by the Positive and Negative Syndrome Scale, will also be evaluated. Data will be collected at baseline, immediately after the last stimulation, and 1 and 2 months thereafter. If active stimulation elicits greater effects compared with those of sham stimulation, it may add to the efforts to improve functional outcomes by neuromodulation in patients with schizophrenia. TRIAL REGISTRATION UMIN000028224; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000032305.
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Affiliation(s)
- Zui Narita
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takuma Inagawa
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazushi Maruo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazuki Sueyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tomiki Sumiyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
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34
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Jahshan C, Rassovsky Y, Green MF. Enhancing Neuroplasticity to Augment Cognitive Remediation in Schizophrenia. Front Psychiatry 2017; 8:191. [PMID: 29021765 PMCID: PMC5623668 DOI: 10.3389/fpsyt.2017.00191] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/15/2017] [Indexed: 12/17/2022] Open
Abstract
There is a burgeoning need for innovative treatment strategies to improve the cognitive deficits in schizophrenia. Cognitive remediation (CR) is effective at the group level, but the variability in treatment response is large. Given that CR may depend on intact neuroplasticity to produce cognitive gains, it is reasonable to combine it with strategies that harness patients' neuroplastic potential. In this review, we discuss two non-pharmacological approaches that can enhance neuroplasticity and possibly augment the effects of CR in schizophrenia: physical exercise and transcranial direct current stimulation (tDCS). Substantial body of evidence supports the beneficial effect of physical exercise on cognition, and a handful of studies in schizophrenia have shown that physical exercise in conjunction with CR has a larger impact on cognition than CR alone. Physical exercise is thought to stimulate neuroplasticity through the regulation of central growth factors, and current evidence points to brain-derived neurotrophic factor as the potential underlying mechanism through which physical exercise might enhance the effectiveness of CR. tDCS has emerged as a potential tool for cognitive enhancement and seems to affect the cellular mechanisms involved in long-term potentiation (LTP). A few reports have demonstrated the feasibility of integrating tDCS with CR in schizophrenia, but there are insufficient data to determine if this multimodal approach leads to incremental performance gain in patients. Larger randomized controlled trials are necessary to understand the mechanisms of the combined tDCS-CR intervention. Future research should take advantage of new developments in neuroplasticity paradigms to examine the effects of these interventions on LTP.
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Affiliation(s)
- Carol Jahshan
- VISN-22 Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Yuri Rassovsky
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychology, Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Michael F Green
- VISN-22 Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Narita Z, Inagawa T, Sueyoshi K, Lin C, Sumiyoshi T. Possible Facilitative Effects of Repeated Anodal Transcranial Direct Current Stimulation on Functional Outcome 1 Month Later in Schizophrenia: An Open Trial. Front Psychiatry 2017; 8:184. [PMID: 29033856 PMCID: PMC5626815 DOI: 10.3389/fpsyt.2017.00184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/11/2017] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Recent research on neuromodulation techniques, such as transcranial direct current stimulation (tDCS), for the treatment of schizophrenia has mainly focused on psychotic symptoms. We aimed to determine whether repetitive tDCS is efficacious in improving determinants of outcome, such as cognitive function, daily living skills, and depressive mood in patients with schizophrenia. Twenty-eight patients underwent tDCS (2 mA × 20 min) two times per day for 5 consecutive days. The anodal electrode was placed over the left dorsolateral prefrontal cortex while the cathodal electrode was placed over the right supraorbital region. One month after the last stimulation, there was a significant improvement on cognitive function, measured by the brief assessment of cognition in schizophrenia (d = 0.49). Significant effects were also shown on daily living skills (functional capacity), measured by the UCSD performance-based skills assessment-brief (d = 0.70). Depressive symptoms, measured by the Calgary depression rating scale, as well as psychotic symptoms measured by on the positive and negative syndrome scale positive and general psychopathology subscales also responded to the treatment (d = 0.38, d = 0.48, and d = 0.50, respectively). This is the first study to suggest that tDCS with the anodal electrode on the left prefrontal cortex improves functional capacity and depressive symptoms in patients with schizophrenia. These results may add to the concept that tDCS provides a strategy to enhance functional outcomes in patients with schizophrenia. TRIAL REGISTRATION https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000018556, UMIN000015953.
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Affiliation(s)
- Zui Narita
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takuma Inagawa
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazuki Sueyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Crystal Lin
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tomiki Sumiyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
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Gögler N, Papazova I, Oviedo-Salcedo T, Filipova N, Strube W, Funk J, Müller HJ, Finke K, Hasan A. Parameter-Based Evaluation of Attentional Impairments in Schizophrenia and Their Modulation by Prefrontal Transcranial Direct Current Stimulation. Front Psychiatry 2017; 8:259. [PMID: 29238310 PMCID: PMC5712554 DOI: 10.3389/fpsyt.2017.00259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/14/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Attentional dysfunctions constitute core cognitive symptoms in schizophrenia, but the precise underlying neurocognitive mechanisms remain to be elucidated. METHODS In this randomized, double-blind, sham-controlled study, we applied, for the first time, a theoretically grounded modeling approach based on Bundesen's Theory of Visual Attention (TVA) to (i) identify specific visual attentional parameters affected in schizophrenia and (ii) assess, as a proof of concept, the potential of single-dose anodal transcranial direct current stimulation (tDCS; 20 min, 2 mA) to the left dorsolateral prefrontal cortex to modulate these attentional parameters. To that end, attentional parameters were measured before (baseline), immediately after, and 24 h after the tDCS intervention in 20 schizophrenia patients and 20 healthy controls. RESULTS At baseline, analyses revealed significantly reduced visual processing speed and visual short-term memory storage capacity in schizophrenia. A significant stimulation condition × time point interaction in the schizophrenia patient group indicated improved processing speed at the follow-up session only in the sham condition (a practice effect), whereas performance remained stable across the three time points in patients receiving verum stimulation. In healthy controls, anodal tDCS did not result in a significant change in attentional performance. CONCLUSION With regard to question (i) above, these findings are indicative of a processing speed and short-term memory deficit as primary sources of attentional deficits in schizophrenia. With regard to question (ii), the efficacy of single-dose anodal tDCS for improving (speed aspects of visual) cognition, it appears that prefrontal tDCS (at the settings used in the present study), rather than ameliorating the processing speed deficit in schizophrenia, actually may interfere with practice-dependent improvements in the rate of visual information uptake. Such potentially unexpected effects of tDCS ought to be taken into consideration when discussing its applicability in psychiatric populations. The study was registered at http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00011665.
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Affiliation(s)
- Nadine Gögler
- Department of Psychology, Ludwig-Maximilians-Universität München, München, Germany
| | - Irina Papazova
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, München, Germany
| | - Tatiana Oviedo-Salcedo
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, München, Germany
| | - Nina Filipova
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, München, Germany
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, München, Germany
| | - Johanna Funk
- Department of Psychology, Ludwig-Maximilians-Universität München, München, Germany
| | - Hermann J Müller
- Department of Psychology, Ludwig-Maximilians-Universität München, München, Germany
| | - Kathrin Finke
- Department of Psychology, Ludwig-Maximilians-Universität München, München, Germany.,Hans-Berger-Department of Neurology, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, München, Germany
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Kindler J, Weickert CS, Schofield PR, Lenroot R, Weickert TW. Raloxifene increases prefrontal activity during emotional inhibition in schizophrenia based on estrogen receptor genotype. Eur Neuropsychopharmacol 2016; 26:1930-1940. [PMID: 27842943 DOI: 10.1016/j.euroneuro.2016.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 09/23/2016] [Accepted: 10/29/2016] [Indexed: 12/16/2022]
Abstract
People with schizophrenia show decreased prefrontal cortex (PFC) activity during emotional response inhibition, a cognitive process sensitive to hormonal influences. Raloxifene, a selective estrogen receptor modulator, binds estrogen receptor alpha (ESR-α), improves memory, attention and normalizes cortical and hippocampal activity during learning and emotional face recognition in schizophrenia. Here, we tested the extent to which raloxifene restores neuronal activity during emotional response inhibition in schizophrenia. Since genetic variation in estrogen receptor alpha (ESR-1) determines cortical ESR-α production and correlates with cognition, we also predicted that genetic ESR-1 variation would differentially relate to increased cortical activity by raloxifene administration. Thirty people with schizophrenia participated in a thirteen-week randomized, double-blind, placebo-controlled, cross-over adjunctive treatment trial of raloxifene administered at 120mg/day. Effects of raloxifene on brain activation were assessed based on ESR-1 genotype using functional magnetic resonance imaging during emotional word inhibition. Raloxifene increased PFC activity during inhibition of response to negative words and the raloxifene related increased PFC activity was greater in patients homozygous for ESR-1 rs9340799 AA relative to G carriers. Comparison to 23 healthy controls demonstrated that PFC activity of people with schizophrenia receiving raloxifene was more similar to controls than to their own brain activity during placebo. Estrogen receptor modulation by raloxifene restores PFC activity during emotional response inhibition in schizophrenia and ESR-1 genotype predicts degree of increased neural activity in response to raloxifene. While these preliminary results require replication, they suggest the potential for personalized pharmacotherapy using ESR-1 and estrogen receptor targeting compounds in schizophrenia.
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Affiliation(s)
- Jochen Kindler
- School of Psychiatry, University of New South Wales, Randwick, NSW 2031 Australia; Neuroscience Research Australia, Randwick, NSW 2031, Australia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Cynthia Shannon Weickert
- School of Psychiatry, University of New South Wales, Randwick, NSW 2031 Australia; Neuroscience Research Australia, Randwick, NSW 2031, Australia; Schizophrenia Research Institute, Randwick, NSW 2031 Australia
| | - Peter R Schofield
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; Schizophrenia Research Institute, Randwick, NSW 2031 Australia; School of Medical Sciences, University of New South Wales, Randwick, Australia
| | - Rhoshel Lenroot
- School of Psychiatry, University of New South Wales, Randwick, NSW 2031 Australia; Neuroscience Research Australia, Randwick, NSW 2031, Australia; Schizophrenia Research Institute, Randwick, NSW 2031 Australia
| | - Thomas W Weickert
- School of Psychiatry, University of New South Wales, Randwick, NSW 2031 Australia; Neuroscience Research Australia, Randwick, NSW 2031, Australia; Schizophrenia Research Institute, Randwick, NSW 2031 Australia.
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Imaging transcranial direct current stimulation (tDCS) of the prefrontal cortex—correlation or causality in stimulation-mediated effects? Neurosci Biobehav Rev 2016; 69:333-56. [DOI: 10.1016/j.neubiorev.2016.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/30/2016] [Accepted: 08/01/2016] [Indexed: 02/03/2023]
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Hasan A, Strube W, Palm U, Wobrock T. Repetitive Noninvasive Brain Stimulation to Modulate Cognitive Functions in Schizophrenia: A Systematic Review of Primary and Secondary Outcomes. Schizophr Bull 2016; 42 Suppl 1:S95-S109. [PMID: 27460623 PMCID: PMC4960427 DOI: 10.1093/schbul/sbv158] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite many years of research, there is still an urgent need for new therapeutic options for the treatment of cognitive deficits in schizophrenia. Noninvasive brain stimulation (NIBS) has been proposed to be such a novel add-on treatment option. The main objective of this review was to systematically evaluate the cognitive effects of repetitive NIBS in schizophrenia. As most studies have not been specifically designed to investigate cognition as primary outcome, we have focused on both, primary and secondary outcomes. The PubMed/MEDLINE database (1985-2015) was systematically searched for interventional studies investigating the effects of repetitive NIBS on schizophrenia symptoms. All interventional clinical trials using repetitive transcranial stimulation, transcranial theta burst stimulation, and transcranial direct current stimulation for the treatment of schizophrenia were extracted and analyzed with regard to cognitive measures as primary or secondary outcomes. Seventy-six full-text articles were assessed for eligibility of which 33 studies were included in the qualitative synthesis. Of these 33 studies, only 4 studies included cognition as primary outcome, whereas 29 studies included cognitive measures as secondary outcomes. A beneficial effect of frontal NIBS could not be clearly established. No evidence for a cognitive disruptive effect of NIBS (temporal lobe) in schizophrenia could be detected. Finally, a large heterogeneity between studies in terms of inclusion criteria, stimulation parameters, applied cognitive measures, and follow-up intervals was observed. This review provides the first systematic overview regarding cognitive effects of repetitive NIBS in schizophrenia.
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Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany;
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas Wobrock
- County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany; Department of Psychiatry and Psychotherapy, Georg-August-University, Göttingen, Germany
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Impey D, de la Salle S, Knott V. Assessment of anodal and cathodal transcranial direct current stimulation (tDCS) on MMN-indexed auditory sensory processing. Brain Cogn 2016; 105:46-54. [DOI: 10.1016/j.bandc.2016.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 03/04/2016] [Accepted: 03/23/2016] [Indexed: 12/20/2022]
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The effect of the interval-between-sessions on prefrontal transcranial direct current stimulation (tDCS) on cognitive outcomes: a systematic review and meta-analysis. J Neural Transm (Vienna) 2016; 123:1159-72. [PMID: 27145765 DOI: 10.1007/s00702-016-1558-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/15/2016] [Indexed: 12/28/2022]
Abstract
Recently, there has been wide interest in the effects of transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (DLPFC) on cognitive functioning. However, many methodological questions remain unanswered. One of them is whether the time interval between active and sham-controlled stimulation sessions, i.e. the interval between sessions (IBS), influences DLPFC tDCS effects on cognitive functioning. Therefore, a systematic review and meta-analysis was performed of experimental studies published in PubMed, Science Direct, and other databases from the first data available to February 2016. Single session sham-controlled within-subject studies reporting the effects of tDCS of the DLPFC on cognitive functioning in healthy controls and neuropsychiatric patients were included. Cognitive tasks were categorized in tasks assessing memory, attention, and executive functioning. Evaluation of 188 trials showed that anodal vs. sham tDCS significantly decreased response times and increased accuracy, and specifically for the executive functioning tasks, in a sample of healthy participants and neuropsychiatric patients (although a slightly different pattern of improvement was found in analyses for both samples separately). The effects of cathodal vs. sham tDCS (45 trials), on the other hand, were not significant. IBS ranged from less than 1 h to up to 1 week (i.e. cathodal tDCS) or 2 weeks (i.e. anodal tDCS). This IBS length had no influence on the estimated effect size when performing a meta-regression of IBS on reaction time and accuracy outcomes in all three cognitive categories, both for anodal and cathodal stimulation. Practical recommendations and limitations of the study are further discussed.
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Hoy KE, Whitty D, Bailey N, Fitzgerald PB. Preliminary investigation of the effects of γ-tACS on working memory in schizophrenia. J Neural Transm (Vienna) 2016; 123:1205-12. [PMID: 27116682 DOI: 10.1007/s00702-016-1554-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/11/2016] [Indexed: 12/25/2022]
Abstract
Working memory impairment in schizophrenia has been strongly associated with abnormalities in gamma oscillations within the dorsolateral prefrontal cortex (DLFPC). We recently published the first ever study showing that anodal transcranial direct current stimulation (tDCS) to the left DLPFC was able to significantly improve working memory in schizophrenia and did so seemingly via restoring normal gamma oscillatory function. Transcranial alternating current stimulation (tACS) is a form of electrical brain stimulation that delivers stimulation at a specific frequency and has been shown to entrain endogenous cortical oscillations. Therefore, gamma (γ) tACS may be even more effective than tDCS in improving working memory in schizophrenia. In a randomized repeated-measures study we compared the effects of γ-tACS, tDCS and sham stimulation on the performance of the two back working memory tasks in ten patients with schizophrenia. There was a significant time by stimulation interaction, with tDCS and sham showing trend-level improvements in working memory, while γ-tACS, contrary to our hypothesis, showed no change. The results are discussed in light of posited divergent effects of tACS and tDCS on the pathophysiology of working memory impairment in schizophrenia.
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Affiliation(s)
- Kate E Hoy
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Central Clinical School, Melbourne, VIC, Australia.
| | - Dean Whitty
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Central Clinical School, Melbourne, VIC, Australia
| | - Neil Bailey
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Central Clinical School, Melbourne, VIC, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Central Clinical School, Melbourne, VIC, Australia
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A Systematic Review and Meta-Analysis of the Effects of Transcranial Direct Current Stimulation (tDCS) Over the Dorsolateral Prefrontal Cortex in Healthy and Neuropsychiatric Samples: Influence of Stimulation Parameters. Brain Stimul 2016; 9:501-17. [PMID: 27160468 DOI: 10.1016/j.brs.2016.04.006] [Citation(s) in RCA: 351] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/08/2016] [Accepted: 04/09/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Research into the effects of transcranial direct current stimulation of the dorsolateral prefrontal cortex on cognitive functioning is increasing rapidly. However, methodological heterogeneity in prefrontal tDCS research is also increasing, particularly in technical stimulation parameters that might influence tDCS effects. OBJECTIVE To systematically examine the influence of technical stimulation parameters on DLPFC-tDCS effects. METHODS We performed a systematic review and meta-analysis of tDCS studies targeting the DLPFC published from the first data available to February 2016. Only single-session, sham-controlled, within-subject studies reporting the effects of tDCS on cognition in healthy controls and neuropsychiatric patients were included. RESULTS Evaluation of 61 studies showed that after single-session a-tDCS, but not c-tDCS, participants responded faster and more accurately on cognitive tasks. Sub-analyses specified that following a-tDCS, healthy subjects responded faster, while neuropsychiatric patients responded more accurately. Importantly, different stimulation parameters affected a-tDCS effects, but not c-tDCS effects, on accuracy in healthy samples vs. PATIENTS increased current density and density charge resulted in improved accuracy in healthy samples, most prominently in females; for neuropsychiatric patients, task performance during a-tDCS resulted in stronger increases in accuracy rates compared to task performance following a-tDCS. CONCLUSIONS Healthy participants respond faster, but not more accurate on cognitive tasks after a-tDCS. However, increasing the current density and/or charge might be able to enhance response accuracy, particularly in females. In contrast, online task performance leads to greater increases in response accuracy than offline task performance in neuropsychiatric patients. Possible implications and practical recommendations are discussed.
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Pérez C, Leite J, Carvalho S, Fregni F. Transcranial Electrical Stimulation (tES) for the Treatment of Neuropsychiatric Disorders Across Lifespan. EUROPEAN PSYCHOLOGIST 2016. [DOI: 10.1027/1016-9040/a000252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract. Transcranial electrical stimulation (tES) is a safe, painless, and inexpensive noninvasive brain stimulation (NIBS) technique. tES has been shown to reduce symptoms in a variety of neuropsychiatric conditions such as depression, schizophrenia, anxiety, autism, and craving. There are many factors that can influence the effects of tES, such as current intensity, duration, baseline level of activity, gender, and age. Age is a critical variable, since the human brain undergoes several anatomic and functional changes across the lifespan. Therefore, tES-induced effects may not be the same across the lifespan. In this review we summarize the effects of tES, including tDCS, tACS, and tRNS, on clinical outcomes in several neuropsychiatric conditions, using a framework in which studies are organized according to the age of subjects. The use of tES in neuropsychiatric disorders has yielded promising results with mild, if any, adverse effects. Most of the published studies with tES have been conducted with tDCS in adult population. Future studies should focus on interventions guided by surrogate outcomes of neuroplasticity. A better understanding of neuroplasticity across the lifespan will help optimize current tES stimulation parameters, especially for use with children and elderly populations.
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Affiliation(s)
- Carolina Pérez
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jorge Leite
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Braga, Portugal
| | - Sandra Carvalho
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Braga, Portugal
| | - Felipe Fregni
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Song B, Wen P, Ahfock T, Li Y. Numeric Investigation of Brain Tumor Influence on the Current Distributions During Transcranial Direct Current Stimulation. IEEE Trans Biomed Eng 2016; 63:176-87. [DOI: 10.1109/tbme.2015.2468672] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Smith RC, Boules S, Mattiuz S, Youssef M, Tobe RH, Sershen H, Lajtha A, Nolan K, Amiaz R, Davis JM. Effects of transcranial direct current stimulation (tDCS) on cognition, symptoms, and smoking in schizophrenia: A randomized controlled study. Schizophr Res 2015; 168:260-6. [PMID: 26190299 DOI: 10.1016/j.schres.2015.06.011] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/10/2015] [Accepted: 06/12/2015] [Indexed: 12/11/2022]
Abstract
Schizophrenia is characterized by cognitive deficits which persist after acute symptoms have been treated or resolved. Transcranial direct current stimulation (tDCS) has been reported to improve cognition and reduce smoking craving in healthy subjects but has not been as carefully evaluated in a randomized controlled study for these effects in schizophrenia. We conducted a randomized double-blind, sham-controlled study of the effects of 5 sessions of tDCS (2 milliamps for 20minutes) on cognition, psychiatric symptoms, and smoking and cigarette craving in 37 outpatients with schizophrenia or schizoaffective disorder who were current smokers. Thirty subjects provided evaluable data on the MATRICS Consensus Cognitive Battery (MCCB), with the primary outcome measure, the MCCB Composite score. Active compared to sham tDCS subjects showed significant improvements after the fifth tDCS session in MCCB Composite score (p=0.008) and on the MCCB Working Memory (p=0.002) and Attention-Vigilance (p=0.027) domain scores, with large effect sizes. MCCB Composite and Working Memory domain scores remained significant at Benjamini-Hochberg corrected significance levels (α=0.05). There were no statistically significant effects on secondary outcome measures of psychiatric symptoms (PANSS scores), hallucinations, cigarette craving, or cigarettes smoked. The positive effects of tDCS on cognitive performance suggest a potential efficacious treatment for cognitive deficits in partially recovered chronic schizophrenia outpatients that should be further investigated.
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Affiliation(s)
- Robert C Smith
- Nathan S. Kline institute for Psychiatric Research, Orangeburg, New York, United states; Department of Psychiatry NYU Langone Medical Center, United States.
| | - Sylvia Boules
- Staten Island University Hospital, Staten Island, New York, United States.
| | - Sanela Mattiuz
- Nathan S. Kline institute for Psychiatric Research, Orangeburg, New York, United states.
| | - Mary Youssef
- Nathan S. Kline institute for Psychiatric Research, Orangeburg, New York, United states.
| | - Russell H Tobe
- Nathan S. Kline institute for Psychiatric Research, Orangeburg, New York, United states.
| | - Henry Sershen
- Nathan S. Kline institute for Psychiatric Research, Orangeburg, New York, United states.
| | - Abel Lajtha
- Nathan S. Kline institute for Psychiatric Research, Orangeburg, New York, United states.
| | - Karen Nolan
- Nathan S. Kline institute for Psychiatric Research, Orangeburg, New York, United states.
| | - Revital Amiaz
- Psychiatry Clinic, The Haim Sheba Medical Center, Affiliated to the Tel - Aviv University Sackler School of Medicine TEL-HASHOMER 52621, Israel.
| | - John M Davis
- University of Illinois College of Medicine Psychiatric Institute, Chicago, Illinois, United States.
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Sale MV, Mattingley JB, Zalesky A, Cocchi L. Imaging human brain networks to improve the clinical efficacy of non-invasive brain stimulation. Neurosci Biobehav Rev 2015; 57:187-98. [DOI: 10.1016/j.neubiorev.2015.09.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/03/2015] [Accepted: 09/22/2015] [Indexed: 01/28/2023]
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Meron D, Hedger N, Garner M, Baldwin DS. Transcranial direct current stimulation (tDCS) in the treatment of depression: Systematic review and meta-analysis of efficacy and tolerability. Neurosci Biobehav Rev 2015; 57:46-62. [PMID: 26232699 DOI: 10.1016/j.neubiorev.2015.07.012] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/24/2015] [Accepted: 07/26/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a potential alternative treatment option for major depressive episodes (MDE). OBJECTIVES We address the efficacy and safety of tDCS in MDE. METHODS The outcome measures were Hedges' g for continuous depression ratings, and categorical response and remission rates. RESULTS A random effects model indicated that tDCS was superior to sham tDCS (k=11, N=393, g=0.30, 95% CI=[0.04, 0.57], p=0.027). Adjunctive antidepressant medication and cognitive control training negatively impacted on the treatment effect. The pooled log odds ratios (LOR) for response and remission were positive, but statistically non-significant (response: k=9, LOR=0.36, 95% CI[-0.16, 0.88], p=0.176, remission: k=9, LOR=0.25, 95% CI [-0.42, 0.91], p=0.468). We estimated that for a study to detect the pooled continuous effect (g=0.30) at 80% power (alpha=0.05), a total N of at least 346 would be required (with the total N required to detect the upper and lower bound being 49 and 12,693, respectively). CONCLUSIONS tDCS may be efficacious for treatment of MDE. The data do not support the use of tDCS in treatment-resistant depression, or as an add-on augmentation treatment. Larger studies over longer treatment periods are needed.
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Affiliation(s)
- Daniel Meron
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Department of Psychiatry, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT, United Kingdom; Avon & Wiltshire Partnership NHS Trust, Jenner House, Langley Park, Chippenham SN15 1GG, Wiltshire, United Kingdom.
| | - Nicholas Hedger
- Psychology, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, United Kingdom.
| | - Matthew Garner
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Department of Psychiatry, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT, United Kingdom; Psychology, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, United Kingdom.
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Department of Psychiatry, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT, United Kingdom; University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
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Rassovsky Y, Dunn W, Wynn J, Wu AD, Iacoboni M, Hellemann G, Green MF. The effect of transcranial direct current stimulation on social cognition in schizophrenia: A preliminary study. Schizophr Res 2015; 165:171-4. [PMID: 25934168 DOI: 10.1016/j.schres.2015.04.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 04/09/2015] [Accepted: 04/12/2015] [Indexed: 12/29/2022]
Abstract
In this preliminary study, we examined the effect of transcranial direct current stimulation (tDCS) on social cognition in 36 individuals with schizophrenia. Participants received a baseline assessment and one week later received either anodal, cathodal, or sham tDCS, with 12 participants randomized to each condition. A single 20-minute session tDCS was administered bilaterally over the dorsolateral prefrontal cortex (centered at positions Fp1 and Fp2) at 2 mA. Among the 4 social cognitive tasks, participants showed a significant improvement on one of them, emotion identification, following anodal stimulation. Findings demonstrate the safety of this procedure and suggest potential therapeutic effects on one aspect of social cognition in schizophrenia.
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Affiliation(s)
- Yuri Rassovsky
- Department of Psychology and Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel; Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
| | - Walter Dunn
- Department of Veteran Affairs VISN-22 Mental Illness Research Education Clinical Center, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Jonathan Wynn
- Department of Veteran Affairs VISN-22 Mental Illness Research Education Clinical Center, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Allan D Wu
- Department of Neurology, University of CA, Los Angeles, USA
| | - Marco Iacoboni
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA; Ahmanson-Lovelace Brain Mapping Center, University of CA, Los Angeles, USA
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA; Department of Veteran Affairs VISN-22 Mental Illness Research Education Clinical Center, Los Angeles, CA, USA
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