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Malekahmad M, Frazer A, Zoghi M, Jaberzadeh S. Transcranial pulsed current stimulation: A scoping review of the current literature on scope, nature, underlying mechanisms, and gaps. Psychophysiology 2024; 61:e14521. [PMID: 38200645 DOI: 10.1111/psyp.14521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/28/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024]
Abstract
Transcranial pulsed current stimulation (tPCS) is a noninvasive brain stimulation technique that has aroused considerable attention in recent years. This review aims to provide an overview of the existing literature on tPCS, examine the scope and nature of previous research, investigate its underlying mechanisms, and identify gaps in the literature. Searching online databases resulted in 36 published tPCS studies from inception until May 2023. These studies were categorized into three groups: human studies on healthy individuals, human studies on clinical conditions, and animal studies. The findings suggest that tPCS has the potential to modulate brain excitability by entraining neural oscillations and utilizing stochastic resonance. However, the underlying mechanisms of tPCS are not yet fully understood and require further investigation. Furthermore, the included studies indicate that tPCS may have therapeutic potential for neurological diseases. However, before tPCS can be applied in clinical settings, a better understanding of its mechanisms is crucial. Hence, the tPCS studies were categorized into four types of research: basic, strategic, applied, and experimental research, to identify the nature of the literature and gaps. Analysis of these categories revealed that tPCS, with its diverse parameters, effects, and mechanisms, presents a wide range of research opportunities for future investigations.
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Affiliation(s)
- Mona Malekahmad
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
| | - Ashlyn Frazer
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
| | - Maryam Zoghi
- Discipline of Physiotherapy, Federation University, Melbourne, Victoria, Australia
| | - Shapour Jaberzadeh
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
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Soldatelli M, Franco ÁDO, Picon F, Duarte JÁ, Scherer R, Bandeira J, Zortea M, Torres ILDS, Fregni F, Caumo W. Primary somatosensory cortex and periaqueductal gray functional connectivity as a marker of the dysfunction of the descending pain modulatory system in fibromyalgia. Korean J Pain 2023; 36:113-127. [PMID: 36581601 PMCID: PMC9812696 DOI: 10.3344/kjp.22225] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 12/31/2022] Open
Abstract
Background Resting-state functional connectivity (rs-FC) may aid in understanding the link between pain-modulating brain regions and the descending pain modulatory system (DPMS) in fibromyalgia (FM). This study investigated whether the differences in rs-FC of the primary somatosensory cortex in responders and non-responders to the conditioned pain modulation test (CPM-test) are related to pain, sleep quality, central sensitization, and the impact of FM on quality of life. Methods This cross-sectional study included 33 females with FM. rs-FC was assessed by functional magnetic resonance imaging. Change in the numerical pain scale during the CPM-test assessed the DPMS function. Subjects were classified either as non-responders (i.e., DPMS dysfunction, n = 13) or responders (n = 20) to CPM-test. A generalized linear model (GLM) and a receiver operating characteristic (ROC) curve analysis were performed to check the accuracy of the rs-FC to differentiate each group. Results Non-responders showed a decreased rs-FC between the left somatosensory cortex (S1) and the periaqueductal gray (PAG) (P < 0.001). The GLM analysis revealed that the S1-PAG rs-FC in the left-brain hemisphere was positively correlated with a central sensitization symptom and negatively correlated with sleep quality and pain scores. ROC curve analysis showed that left S1-PAG rs-FC offers a sensitivity and specificity of 85% or higher (area under the curve, 0.78, 95% confidence interval, 0.63-0.94) to discriminate who does/does not respond to the CPM-test. Conclusions These results support using the rs-FC patterns in the left S1-PAG as a marker for predicting CPM-test response, which may aid in treatment individualization in FM patients.
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Affiliation(s)
- Matheus Soldatelli
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Álvaro de Oliveira Franco
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Felipe Picon
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Psychiatry, Faculdade de Medicina, UFRGS, Porto Alegre, Brazil
- ADHD Outpatient Program, HCPA, Porto Alegre, Brazil
| | - Juliana Ávila Duarte
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Internal Medicine, UFRGS, Porto Alegre, Brazil
| | - Ricardo Scherer
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Janete Bandeira
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Maxciel Zortea
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Iraci Lucena da Silva Torres
- Laboratory of Pharmacology in Pain and Neuromodulation: Pre-clinical Investigations, Experimental Research Center, HCPA, Porto Alegre, Brazil
| | - Felipe Fregni
- Pain and Palliative Care Service, HCPA, Porto Alegre, Brazil
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Pain and Palliative Care Service, HCPA, Porto Alegre, Brazil
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, USA
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Wang WJ, Zhong YB, Zhao JJ, Ren M, Zhang SC, Xu MS, Xu ST, Zhang YJ, Shan CL. Transcranial pulse current stimulation improves the locomotor function in a rat model of stroke. Neural Regen Res 2021; 16:1229-1234. [PMID: 33318399 PMCID: PMC8284281 DOI: 10.4103/1673-5374.301018] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Previous studies have shown that transcranial pulse current stimulation (tPCS) can increase cerebral neural plasticity and improve patients’ locomotor function. However, the precise mechanisms underlying this effect remain unclear. In the present study, rat models of stroke established by occlusion of the right cerebral middle artery were subjected to tPCS, 20 minutes per day for 7 successive days. tPCS significantly reduced the Bederson score, increased the foot print area of the affected limbs, and reduced the standing time of affected limbs of rats with stroke compared with that before intervention. Immunofluorescence staining and western blot assay revealed that tPCS significantly increased the expression of microtubule-associated protein-2 and growth-associated protein-43 around the ischemic penumbra. This finding suggests that tPCS can improve the locomotor function of rats with stroke by regulating the expression of microtubule-associated protein-2 and growth-associated protein-43 around the ischemic penumbra. These findings may provide a new method for the clinical treatment of poststroke motor dysfunction and a theoretical basis for clinical application of tPCS. The study was approved by the Animal Use and Management Committee of Shanghai University of Traditional Chinese Medicine of China (approval No. PZSHUTCM190315003) on February 22, 2019.
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Affiliation(s)
- Wen-Jing Wang
- Center of Rehabilitation, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine; School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan-Biao Zhong
- Center of Rehabilitation, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing-Jun Zhao
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai; Department of Rehabilitation Medicine, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan Province, China
| | - Meng Ren
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Si-Cong Zhang
- Center of Rehabilitation, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine; School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ming-Shu Xu
- Laboratory of Neurobiology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Shu-Tian Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying-Jie Zhang
- Laboratory of Neurobiology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Chun-Lei Shan
- Center of Rehabilitation, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine; School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Dissanayaka T, Zoghi M, Farrell M, Egan G, Jaberzadeh S. The effects of a single-session cathodal transcranial pulsed current stimulation on corticospinal excitability: A randomized sham-controlled double-blinded study. Eur J Neurosci 2020; 52:4908-4922. [PMID: 33128480 DOI: 10.1111/ejn.14916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 06/16/2020] [Accepted: 07/11/2020] [Indexed: 12/17/2022]
Abstract
Transcranial pulsed current stimulation (tPCS) of the human motor cortex has received much attention in recent years. Although the effect of anodal tPCS with different frequencies has been investigated, the effect of cathodal tPCS (c-tPCS) has not been explored yet. Therefore, the aim of the present study was to investigate the effect of c-tPCS at 4 and 75 Hz frequencies on corticospinal excitability (CSE) and motor performance. In a randomized sham-controlled crossover design, fifteen healthy participants attended three experimental sessions and received either c-tPCS at 75 Hz, 4 Hz or sham with 1.5 mA for 15 min. Transcranial magnetic stimulation and grooved pegboard test were performed before, immediately after and 30 min after the completion of stimulation at rest. The findings indicate that c-tPCS at both 4 and 75 Hz significantly increased CSE compared to sham. Both c-tPCS at 75 and 4 Hz showed a significant increase in intracortical facilitation compared to sham, whereas the effect on short-interval intracortical inhibition was not significant. The c-tPCS at 4 Hz but not 75 Hz induced modulation of intracortical facilitation correlated with the CSE. Motor performance did not show any significant changes. These results suggest that, compared with sham stimulation, c-tPCS at both 4 and 75 Hz induces an increase in CSE.
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Affiliation(s)
- Thusharika Dissanayaka
- Non-invasive Brain Stimulation & Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Maryam Zoghi
- Department of Rehabilitation, Nutrition and Sport, School of Allied health, La Trobe University, Bundoora, Melbourne, Vic., Australia
| | - Michael Farrell
- Monash Biomedical Imaging, Monash University, Melbourne, Vic., Australia.,Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Vic., Australia
| | - Gary Egan
- Monash Biomedical Imaging, Monash University, Melbourne, Vic., Australia
| | - Shapour Jaberzadeh
- Non-invasive Brain Stimulation & Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
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Bikson M, Esmaeilpour Z, Adair D, Kronberg G, Tyler WJ, Antal A, Datta A, Sabel BA, Nitsche MA, Loo C, Edwards D, Ekhtiari H, Knotkova H, Woods AJ, Hampstead BM, Badran BW, Peterchev AV. Transcranial electrical stimulation nomenclature. Brain Stimul 2019; 12:1349-1366. [PMID: 31358456 DOI: 10.1016/j.brs.2019.07.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/25/2019] [Accepted: 07/14/2019] [Indexed: 01/03/2023] Open
Abstract
Transcranial electrical stimulation (tES) aims to alter brain function non-invasively by applying current to electrodes on the scalp. Decades of research and technological advancement are associated with a growing diversity of tES methods and the associated nomenclature for describing these methods. Whether intended to produce a specific response so the brain can be studied or lead to a more enduring change in behavior (e.g. for treatment), the motivations for using tES have themselves influenced the evolution of nomenclature, leading to some scientific, clinical, and public confusion. This ambiguity arises from (i) the infinite parameter space available in designing tES methods of application and (ii) varied naming conventions based upon the intended effects and/or methods of application. Here, we compile a cohesive nomenclature for contemporary tES technologies that respects existing and historical norms, while incorporating insight and classifications based on state-of-the-art findings. We consolidate and clarify existing terminology conventions, but do not aim to create new nomenclature. The presented nomenclature aims to balance adopting broad definitions that encourage flexibility and innovation in research approaches, against classification specificity that minimizes ambiguity about protocols but can hinder progress. Constructive research around tES classification, such as transcranial direct current stimulation (tDCS), should allow some variations in protocol but also distinguish from approaches that bear so little resemblance that their safety and efficacy should not be compared directly. The proposed framework includes terms in contemporary use across peer-reviewed publications, including relatively new nomenclature introduced in the past decade, such as transcranial alternating current stimulation (tACS) and transcranial pulsed current stimulation (tPCS), as well as terms with long historical use such as electroconvulsive therapy (ECT). We also define commonly used terms-of-the-trade including electrode, lead, anode, and cathode, whose prior use, in varied contexts, can also be a source of confusion. This comprehensive clarification of nomenclature and associated preliminary proposals for standardized terminology can support the development of consensus on efficacy, safety, and regulatory standards.
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Affiliation(s)
- Marom Bikson
- Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA.
| | - Zeinab Esmaeilpour
- Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA.
| | - Devin Adair
- Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA
| | - Greg Kronberg
- Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA
| | - William J Tyler
- Arizona State University, School of Biological and Health Systems Engineering, Tempe, AZ, USA
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center Goettingen, Goettingen, Germany; Institute of Medical Psychology, Medical Faculty, Otto-v.-Guericke University of Magdeburg, Magdeburg, Germany
| | | | - Bernhard A Sabel
- Institute of Medical Psychology, Medical Faculty, Otto-v.-Guericke University of Magdeburg, Magdeburg, Germany
| | - Michael A Nitsche
- Leibniz Research Centre for Working Environment ant Human Factors, Dept. Psychology and Neurosciences, Dortmund, Germany; University Medical Hospital Bergmannsheil, Dept. Neurology, Bochum, Germany
| | - Colleen Loo
- School of Psychiatry & Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Dylan Edwards
- Moss Rehabilitation Research Institute, Philadelphia, PA, USA; Edith Cowan University, Joondalup, Australia
| | | | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Benjamin M Hampstead
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Bashar W Badran
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Angel V Peterchev
- Department of Psychiatry & Behavioral Sciences, Department of Biomedical Engineering, Department of Electrical & Computer Engineering, Department of Neurosurgery, Duke University, Durham, NC, USA
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Changes in resting state functional connectivity after repetitive transcranial direct current stimulation applied to motor cortex in fibromyalgia patients. Arthritis Res Ther 2016; 18:40. [PMID: 26842987 PMCID: PMC4741001 DOI: 10.1186/s13075-016-0934-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/18/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Fibromyalgia (FM) is a chronic, centralized pain condition characterized by alterations in the functional, chemical, and structural brain networks responsible for sensory and mood processing. Transcranial direct current stimulation (tDCS) has emerged as a potential treatment for FM. tDCS can alter functional connectivity (FC) in brain regions underneath and distant to the stimulating electrode, although the analgesic mechanisms of repetitive tDCS remain unknown. The aim of this study was to investigate how a clinically relevant schedule of tDCS sessions alters resting state FC and how these changes might relate to clinical pain. METHODS Resting state functional magnetic resonance imaging data were collected from 12 patients with FM at baseline, after 5 days of sham treatment, and after 5 days of real tDCS with the anode over the left primary motor cortex (M1) and the cathode over the right supraorbital cortex. Seed to whole-brain FC analyses were performed with seed regions placed in bilateral M1, primary somatosensory cortices (S1), ventral lateral (VL) and ventral posterolateral (VPL) thalami, and periaqueductal gray (PAG). RESULTS Stronger baseline FC between M1-VL thalamus, S1-anterior insula, and VL thalamus-PAG predicted greater analgesia after sham and real tDCS. Sham treatment (compared with baseline) reduced FC between the VPL thalamus, S1, and the amygdala. Real tDCS (compared with sham treatment) reduced FC between the VL thalamus, medial prefrontal, and supplementary motor cortices. Interestingly, decreased FC between the VL/VPL thalamus and posterior insula, M1, and S1 correlated with reductions in clinical pain after both sham and active treatments. CONCLUSIONS These results suggest that while there may be a placebo response common to both sham and real tDCS, repetitive M1 tDCS causes distinct changes in FC that last beyond the stimulation period and may produce analgesia by altering thalamic connectivity.
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