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Olgiati E, Violante IR, Xu S, Sinclair TG, Li LM, Crow JN, Kapsetaki ME, Calvo R, Li K, Nayar M, Grossman N, Patel MC, Wise RJS, Malhotra PA. Targeted non-invasive brain stimulation boosts attention and modulates contralesional brain networks following right hemisphere stroke. Neuroimage Clin 2024; 42:103599. [PMID: 38608376 PMCID: PMC11019269 DOI: 10.1016/j.nicl.2024.103599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024]
Abstract
Right hemisphere stroke patients frequently present with a combination of lateralised and non-lateralised attentional deficits characteristic of the neglect syndrome. Attentional deficits are associated with poor functional outcome and are challenging to treat, with non-lateralised deficits often persisting into the chronic stage and representing a common complaint among patients and families. In this study, we investigated the effects of non-invasive brain stimulation on non-lateralised attentional deficits in right-hemispheric stroke. In a randomised double-blind sham-controlled crossover study, twenty-two patients received real and sham transcranial Direct Current Stimulation (tDCS) whilst performing a non-lateralised attentional task. A high definition tDCS montage guided by stimulation modelling was employed to maximise current delivery over the right dorsolateral prefrontal cortex, a key node in the vigilance network. In a parallel study, we examined brain network response to this tDCS montage by carrying out concurrent fMRI during stimulation in healthy participants and patients. At the group level, stimulation improved target detection in patients, reducing overall error rate when compared with sham stimulation. TDCS boosted performance throughout the duration of the task, with its effects briefly outlasting stimulation cessation. Exploratory lesion analysis indicated that response to stimulation was related to lesion location rather than volume. In particular, reduced stimulation response was associated with damage to the thalamus and postcentral gyrus. Concurrent stimulation-fMRI revealed that tDCS did not affect local connectivity but influenced functional connectivity within large-scale networks in the contralesional hemisphere. This combined behavioural and functional imaging approach shows that brain stimulation targeted to surviving tissue in the ipsilesional hemisphere improves non-lateralised attentional deficits following stroke. This effect may be exerted via contralesional network effects.
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Affiliation(s)
- Elena Olgiati
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK.
| | - Ines R Violante
- Imperial College London, Department of Brain Sciences, UK; University of Surrey, Department of Psychology, UK
| | - Shuler Xu
- Imperial College London, Department of Brain Sciences, UK; University College London, UK
| | | | - Lucia M Li
- Imperial College London, Department of Brain Sciences, UK; UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK
| | - Jennifer N Crow
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK
| | | | - Roberta Calvo
- UTHealth, Department of Neurobiology and Anatomy, McGovern Medical School, Houston, US
| | - Korina Li
- Imperial College London, Department of Brain Sciences, UK; University College London, UK
| | | | - Nir Grossman
- Imperial College London, Department of Brain Sciences, UK; UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK
| | - Maneesh C Patel
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK
| | - Richard J S Wise
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK
| | - Paresh A Malhotra
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK; UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK
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Hasırcı Bayır BR, Aksu S, Gezegen H, Karaaslan Z, Yüceer H, Cerrahoğlu Şirin T, Küçükali Cİ, Kurt A, Karamürsel S, Yılmaz V, Baykan B. Effects of Transcranial Direct Current Stimulation on Clinical Outcomes, Calcitonin Gene-Related Peptide, and Pituitary Adenylate Cyclase-Activating Polypeptide-38 Levels in Menstrual Migraine. Neuromodulation 2024:S1094-7159(24)00054-0. [PMID: 38506767 DOI: 10.1016/j.neurom.2024.01.005] [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: 05/24/2023] [Revised: 12/27/2023] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Transcranial direct current stimulation (tDCS) has been suggested as an alternative treatment option for migraine. The present study aimed to evaluate the efficacy of tDCS on clinical outcomes in addition to calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating peptide 38 (PACAP-38) levels in individuals with menstrual-related migraine (MRM) for the first time. MATERIALS AND METHODS In this parallel study, 58 female patients between the ages of 18 and 45 years, including 36 with MRM and 22 with nonmenstrual migraines (nMM), were recruited. Sessions of 2-mA 20-minute anodal tDCS were administered over the left dorsolateral prefrontal cortex within three consecutive days (1:1 active and sham stimulation). Migraine attack frequency, severity, analgesic usage, CGRP, and PACAP-38 levels of the patients were evaluated before and one month after tDCS. RESULTS After tDCS, in the active group compared with the sham group, the frequency (p = 0.031), the severity of attacks (p = 0.003), the number of days with headache (p = 0.004), and the analgesic usage (p = 0.024) were all decreased. In both MRM and nMM groups, the frequency and severity of attacks and analgesic usage were decreased in those receiving active stimulation (p < 0.001 for each). CGRP and PACAP-38 levels were no different in the active group and the sham group after tDCS. CONCLUSIONS tDCS was shown to be efficacious in migraine prophylaxis and a valuable option for migraine and MRM treatment. The absence of changes in serum CGRP and PACAP-38 levels suggests that tDCS efficacy may stem from distinct cerebral electrophysiological mechanisms.
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Affiliation(s)
- Buse Rahime Hasırcı Bayır
- Haydarpaşa Numune Reasearch and Training Hospital, Istanbul, Turkey; Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Serkan Aksu
- Department of Physiology, Muğla Sıtkı Koçman University, Muğla, Turkey; Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Haşim Gezegen
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zerrin Karaaslan
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Hande Yüceer
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Tuba Cerrahoğlu Şirin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Şişli Etfal Research and Training Hospital, Istanbul, Turkey
| | - Cem İsmail Küçükali
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Adnan Kurt
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Sacit Karamürsel
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Vuslat Yılmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
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Sharma N, Bansal S, Dube O, Kaur S, Kumar P, Kapoor G. The combined effect of neuro-modulation and neuro-stimulation on pain in patients with cervical radiculopathy - a double-blinded, two-arm parallel randomized controlled trial. J Spinal Cord Med 2024:1-11. [PMID: 38241510 DOI: 10.1080/10790268.2023.2293328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
INTRODUCTION Cervical radiculopathy is one of those disabling conditions which results in central and peripheral pain and thus affects the quality of life. Transcutaneous Electrical Nerve Stimulation (TENS) and exercises produce analgesic effect but their long-term effect has not been available to date. Transcranial Direct Current stimulation (tDCS) is known to produce promising effects on central pain by targeting cortical activity. PURPOSE To determine the combined effect of tDCS and TENS with exercises on pain and quality of life in patients with cervical radiculopathy. METHOD Forty four patients (male: female = 26:18) of the age group 18-50 years were recruited and randomly allocated into the experimental group and control group. The experimental group received active anodal tDCS for 20 min with an intensity of 2 mA, while the control group received sham anodal tDCS. TENS over the pain distribution area for 20 min with 5 Hz intensity and 80-150 ms pulse duration followed by neck-specific exercises were given in both groups. This protocol was given 5 days a week for 4 weeks. Pre and post-assessments were obtained through outcome measures that the Numeric Pain Rating Scale and Neck Disability Index for the measurement of pain, functional disability, and quality of life. RESULT Paired t-test/Wilcoxon-Signed Rank test, and Index and Mann-Whitney U test were used to compare the demographic variables within and across the groups, respectively for Neck Disability for Numeric Pain Rating Scale, keeping the P-value < 0.05 as significant. One-way repeated-measures analysis of variance (ANOVA) was applied to determine the between-subject factor differences. Post hoc tests with Bonferroni correction for repeated analyses were performed. Results depicted a significant effect for NDI (P = 0.001 for both groups) and NPRS (P = 0.003 for the experimental group and 0.007 for the control group). Significant Interaction effect (time*group) was observed for NDI (F = 42, 5382.77) and NPRS (F = 42, 1844.57) with a P-value of 0.001 for both outcome measures. Clinical significance was observed for both outcome measures having a mean difference in 50.21 and 4.57 for NDI and NPRS, respectively compared with the established MCID of 13.2 and 2.2 scores for respective outcome measures. CONCLUSION It was concluded that active tDCS along with TENS and exercise intervention was effective on pain, disability, and quality of life in patients with cervical radiculopathy.
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Affiliation(s)
- Nidhi Sharma
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Ambala, India
| | - Sidharth Bansal
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Ambala, India
| | - Orneesh Dube
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Ambala, India
| | - Simranjeet Kaur
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Ambala, India
| | - Parveen Kumar
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Ambala, India
- Pal Physiotherapy Clinic, Pal Healthcare, Ambala City, India
| | - Gaurav Kapoor
- Department of Physiotherapy, School of Allied Medical Sciences, Lovely Professional University, Phagwara, Punjab, India
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Hanna MHZ, RezkAllah SS, Shalaby AS, Hanna MZ. Efficacy of transcranial direct current stimulation (tDCS) on pain and shoulder range of motion in post-mastectomy pain syndrome patients: a randomized-control trial. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2023. [DOI: 10.1186/s43161-022-00116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Abstract
Background
Post-mastectomy pain syndrome (PMPS) is a highly prevalent complication after surgical treatment for breast cancer, and it affects the patient’s quality of life in aspects of losing shoulder full range of motion, pain, and depression. Transcranial direct current stimulation (tDCS) is non-invasive brain stimulation technique that was used in numerous clinical applications and in pain reduction in cancer patients. However, the effectiveness of tDCS on PMPS has never been evaluated in an experimental study.
Aim
To investigate the effect of bilateral anodal tDCS of motor cortex (M1) on pain, depression, and shoulder range of motion (ROM) in post-mastectomy pain syndrome.
Study design
Randomized controlled trial.
Methods
A total of 30 female patients with post-mastectomy neuropathic pain were randomized into two groups; the intervention group which received bilateral tDCS on motor cortex (M1) and the control group that received sham bilateral tDCS on M1. As pain affects shoulder range of motion (ROM), shoulder ROM was measured by electronic goniometer pre- and post-tDCS application. In addition, the levels of pain and depression have been measured pre and post treatment. Pain has been measured with visual analogue scale (VAS) and depression with Beck-Depression-Inventory-BDI questionnaire (BDI).
Results
A significant difference was noted in group A regarding pain, depression and shoulder ROM (p= 0.001, p= 0.003, and p= 0.003, respectively). Between group comparison revealed a significant difference of VAS scores and shoulder flexion ROM between groups, the study group and the control group (p=0.041 and 0.048, respectively). Pain decreased by 32% and Shoulder flexion increased by 4.8% post-treatment while there were no significant difference in group B (p=0.567 and p=0.866, respectively).
Conclusions
The application of tDCS decreases the severity of pain and improves shoulder range of motion suffered by breast cancer patients after total mastectomy surgery.
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Yang Y, Xu H, Deng Z, Cheng W, Zhao X, Wu Y, Chen Y, Wei G, Liu Y. Functional connectivity and structural changes of thalamic subregions in episodic migraine. J Headache Pain 2022; 23:119. [PMID: 36088305 PMCID: PMC9463803 DOI: 10.1186/s10194-022-01491-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background The thalamus plays a crucial role in transmitting nociceptive information to various cortical regions involving migraine-related allodynia and photophobia. Abnormal structural and functional alterations related to the thalamus have been well established. However, it is unknown whether the brain structure and function of the thalamic subregions are differentially affected in this disorder. In this study, we aimed to clarify this issue by comparing the structure and function of 16 thalamic subregions between patients with episodic migraine (EM) and healthy controls (HCs). Methods Twenty-seven patients with EM and 30 sex-, age- and education-matched HCs underwent resting-state functional and structural magnetic resonance imaging scans. Functional connectivity (rsFC), grey matter volume (GMV), and diffusion tensor imaging (DTI) parameters of each subregion of the thalamus were calculated and compared between the two groups. Furthermore, correlation analyses between neuroimaging changes and clinical features were performed in this study. Results First, compared with HCs, patients with EM exhibited decreased rsFC between the anterior-medial-posterior subregions of the thalamus and brain regions mainly involved in the medial system of the pain processing pathway and default mode network (DMN). Second, for the whole thalamus and each of its subregions, there were no significant differences in GMV between patients with EM and HCs (P > 0.05, Bonferroni corrected). Third, there was no significant difference in DTI parameters between the two groups (P > 0.05). Finally, decreased rsFC was closely related to scores on the Hamilton Rating Scale for Anxiety (HAMA) and Big Five Inventory (BFI) scales. Conclusion Selective functional hypoconnectivity in the thalamic subregions provides neuroimaging evidence supporting the important role of thalamocortical pathway dysfunction in episodic migraine, specifically, that it may modulate emotion and different personality traits in migraine patients.
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Serrano PV, Zortea M, Alves RL, Beltrán G, Bavaresco C, Ramalho L, Alves CFDS, Medeiros L, Sanches PRS, Silva DP, Lucena da Silva Torres I, Fregni F, Caumo W. The effect of home-based transcranial direct current stimulation in cognitive performance in fibromyalgia: A randomized, double-blind sham-controlled trial. Front Hum Neurosci 2022; 16:992742. [PMID: 36504629 PMCID: PMC9730884 DOI: 10.3389/fnhum.2022.992742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background Transcranial Direct Current Stimulation (tDCS) is a promising approach to improving fibromyalgia (FM) symptoms, including cognitive impairment. So, we evaluated the efficacy and safety of home-based tDCS in treating cognitive impairment. Besides, we explored if the severity of dysfunction of the Descendant Pain Modulation System (DPMS) predicts the tDCS effect and if its effect is linked to changes in neuroplasticity as measured by the brain-derived neurotrophic factor (BDNF). Methods This randomized, double-blind, parallel, sham-controlled clinical trial, single-center, included 36 women with FM, aged from 30 to 65 years old, assigned 2:1 to receive a-tDCS (n = 24) and s-tDCS (n = 12). The primary outcome was the Trail Making Test's assessment of executive attention, divided attention, working memory (WM), and cognitive flexibility (TMT-B-A). The secondary outcomes were the Controlled Oral Word Association Test (COWAT), the WM by Digits subtest from the Wechsler Adult Intelligence Scale (WAIS-III), and quality of life. Twenty-minute daily sessions of home-based tDCS for 4 weeks (total of 20 sessions), 2 mA anodal-left (F3) and cathodal-right (F4) prefrontal stimulation with 35 cm2 carbon electrodes. Results GLM showed a main effect for treatment in the TMT-B-A [Wald χ2 = 6.176; Df = 1; P = 0.03]. The a-tDCS improved cognitive performance. The effect size estimated by Cohen's d at treatment end in the TMT-B-A scores was large [-1.48, confidence interval (CI) 95% = -2.07 to-0.90]. Likewise, the a-tDCS effects compared to s-tDCS improved performance in the WM, verbal and phonemic fluency, and quality-of-life scale. The impact of a-tDCS on the cognitive tests was positively correlated with the reduction in serum BDNF from baseline to treatment end. Besides, the decrease in the serum BDNF was positively associated with improving the quality of life due to FM symptoms. Conclusion These findings revealed that daily treatment with a home-based tDCS device over l-DLPFC compared to sham stimulation over 4 weeks improved the cognitive impairment in FM. The a-tDCS at home was well-tolerated, underlining its potential as an alternative treatment for cognitive dysfunction. Besides, the a-tDCS effect is related to the severity of DPMS dysfunction and changes in neuroplasticity state. Clinical trial registration [www.ClinicalTrials.gov], identifier [NCT03843203].
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Affiliation(s)
- Paul Vicuña Serrano
- 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
| | - Maxciel Zortea
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Centro Universitário Cesuca, Cachoeirinha, Brazil
| | - Rael Lopes Alves
- 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
| | - Gerardo Beltrán
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Institute of Neurosciences of the Universidad Catolica de Cuenca, UCACUE, Cuenca, Ecuador
| | - Cibely Bavaresco
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Leticia Ramalho
- 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
| | - Camila Fernanda da Silveira Alves
- 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
| | - Liciane Medeiros
- 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,Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Universidade La Salle, Canoas, Brazil
| | | | - Danton P. Silva
- Laboratory of Biomedical Engineer at HCPA, Porto Alegre, Brazil
| | - Iraci Lucena da Silva Torres
- Pain and Palliative Care Service at HCPA, Porto Alegre, Brazil,Laboratorio de Farmacologia da Dor e Neuromodulação: Investigacoes Pre-clinicas, Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Felipe Fregni
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Laboratory of Neuromodulation, Department of Physics and Rehabilitation, Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - 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 at HCPA, Porto Alegre, Brazil,Laboratory of Neuromodulation, Department of Physics and Rehabilitation, Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Boston, MA, United States,Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,*Correspondence: Wolnei Caumo,
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Alcon CA, Wang-Price S. Non-invasive brain stimulation and pain neuroscience education in the cognitive-affective treatment of chronic low back pain: Evidence and future directions. FRONTIERS IN PAIN RESEARCH 2022; 3:959609. [PMID: 36438443 PMCID: PMC9686004 DOI: 10.3389/fpain.2022.959609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic low back pain (CLBP) is among the leading causes of disability worldwide. Beyond the physical and functional limitations, people's beliefs, cognitions, and perceptions of their pain can negatively influence their prognosis. Altered cognitive and affective behaviors, such as pain catastrophizing and kinesiophobia, are correlated with changes in the brain and share a dynamic and bidirectional relationship. Similarly, in the presence of persistent pain, attentional control mechanisms, which serve to organize relevant task information are impaired. These deficits demonstrate that pain may be a predominant focus of attentional resources, leaving limited reserve for other cognitively demanding tasks. Cognitive dysfunction may limit one's capacity to evaluate, interpret, and revise the maladaptive thoughts and behaviors associated with catastrophizing and fear. As such, interventions targeting the brain and resultant behaviors are compelling. Pain neuroscience education (PNE), a cognitive intervention used to reconceptualize a person's pain experiences, has been shown to reduce the effects of pain catastrophizing and kinesiophobia. However, cognitive deficits associated with chronic pain may impact the efficacy of such interventions. Non-invasive brain stimulation (NIBS), such as transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective in the treatment of anxiety, depression, and pain. In addition, as with the treatment of most physical and psychological diagnoses, an active multimodal approach is considered to be optimal. Therefore, combining the neuromodulatory effects of NIBS with a cognitive intervention such as PNE could be promising. This review highlights the cognitive-affective deficits associated with CLBP while focusing on current evidence for cognition-based therapies and NIBS.
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Affiliation(s)
- Cory A. Alcon
- Department of Physical Therapy, High Point University, High Point, NC, United States
- School of Physical Therapy, Texas Woman’s University, Dallas, TX, United States
- Correspondence: Cory A. Alcon
| | - Sharon Wang-Price
- School of Physical Therapy, Texas Woman’s University, Dallas, TX, United States
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Bonassi G, Lagravinese G, Putzolu M, Botta A, Bove M, Pelosin E, Avanzino L. Transcranial direct current stimulation alters sensorimotor modulation during cognitive representation of movement. Front Hum Neurosci 2022; 16:862013. [PMID: 36277054 PMCID: PMC9583391 DOI: 10.3389/fnhum.2022.862013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
We recently demonstrated, by means of short latency afferent inhibition (SAI), that before an imagined movement, during the reaction time (RT), SAI decreases only in the movement-related muscle (sensorimotor modulation) and that a correlation exists between sensorimotor modulation and motor imagery (MI) ability. Excitatory anodal transcranial direct current stimulation (a-tDCS) on M1 could enhance the MI outcome; however, mechanisms of action are not completely known. Here, we assessed if a-tDCS on M1 prior to an MI task could affect sensorimotor modulation. Participants imagined abducting the index or little finger in response to an acoustic signal. SAI was evaluated from the first dorsal interosseus after the “go” signal, before the expected electromyographic (EMG) activity. Participants received 20-min 1.5 mA a-tDCS or sham-tDCS on M1 on two different days, in random order. Results showed that a-tDCS on M1 increases the sensorimotor modulation consisting of a weakening of SAI after the Go signal with respect to sham-tDCS, in the movement-related muscle right before the beginning of MI. These results suggest that a-tDCS on M1 further potentiate those circuits responsible for sensorimotor modulation in the RT phase of MI. Increased sensorimotor modulation during MI may be one of the mechanisms involved in MI improvement after a-tDCS over M1.
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Affiliation(s)
- Gaia Bonassi
- S.C. Medicina Fisica e Riabilitazione Ospedaliera, ASL4, Azienda Sanitaria Locale Chiavarese, Chiavari, Italy
| | - Giovanna Lagravinese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Martina Putzolu
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Alessandro Botta
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Marco Bove
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Laura Avanzino
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
- *Correspondence: Laura Avanzino
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Aksu S, Şirin TC, Hasırcı Bayır BR, Ulukan Ç, Soyata AZ, Kurt A, Karamürsel S, Baykan B. Long-Term Prophylactic Transcranial Direct Current Stimulation Ameliorates Allodynia and Improves Clinical Outcomes in Individuals With Migraine. Neuromodulation 2022:S1094-7159(22)00759-0. [DOI: 10.1016/j.neurom.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/27/2022] [Accepted: 06/28/2022] [Indexed: 10/15/2022]
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Wang S, Wen H, Qiu S, Xie P, Qiu J, He H. Driving brain state transitions in major depressive disorder through external stimulation. Hum Brain Mapp 2022; 43:5326-5339. [PMID: 35808927 PMCID: PMC9812249 DOI: 10.1002/hbm.26006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/27/2022] [Accepted: 06/22/2022] [Indexed: 01/15/2023] Open
Abstract
Major depressive disorder (MDD) as a dysfunction of neural circuits and brain networks has been established in modern neuroimaging sciences. However, the brain state transitions between MDD and health through external stimulation remain unclear, which limits translation to clinical contexts and demonstrable clinical utility. We propose a framework of the large-scale whole-brain network model for MDD linking the underlying anatomical connectivity with functional dynamics obtained from diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI). Then, we further explored the optimal brain regions to promote the transition of brain states between MDD and health through external stimulation of the model. Based on the whole-brain model successfully fitting the brain state space in MDD and the health, we demonstrated that the transition from MDD to health is achieved by the excitatory activation of the limbic system and from health to MDD by the inhibitory stimulation of the reward circuit. Our finding provides novel biophysical evidence for the neural mechanism of MDD and its recovery and allows the discovery of new stimulation targets for MDD recovery.
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Affiliation(s)
- Shengpei Wang
- Research Centre for Brain‐inspired Intelligence and National Laboratory of Pattern Recognition, Institute of AutomationChinese Academy of SciencesBeijingChina
| | - Hongwei Wen
- Key Laboratory of Cognition and Personality (Ministry of Education)ChongqingChina,School of PsychologySouthwest UniversityChongqingChina
| | - Shuang Qiu
- Research Centre for Brain‐inspired Intelligence and National Laboratory of Pattern Recognition, Institute of AutomationChinese Academy of SciencesBeijingChina
| | - Peng Xie
- Institute of NeuroscienceChongqing Medical UniversityChongqingChina,Chongqing Key Laboratory of NeurobiologyChongqingChina,Department of Neurologythe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Jiang Qiu
- Key Laboratory of Cognition and Personality (Ministry of Education)ChongqingChina,School of PsychologySouthwest UniversityChongqingChina
| | - Huiguang He
- Research Centre for Brain‐inspired Intelligence and National Laboratory of Pattern Recognition, Institute of AutomationChinese Academy of SciencesBeijingChina,University of Chinese Academy of SciencesBeijingChina,Center for Excellence in Brain Science and Intelligence TechnologyChinese Academy of SciencesBeijingChina
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11
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de Oliveira Franco Á, da Silveira Alves CF, Vicuña P, Bandeira J, de Aratanha MA, Torres ILS, Fregni F, Caumo W. Hyper-connectivity between the left motor cortex and prefrontal cortex is associated with the severity of dysfunction of the descending pain modulatory system in fibromyalgia. PLoS One 2022; 17:e0247629. [PMID: 35622879 PMCID: PMC9140239 DOI: 10.1371/journal.pone.0247629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/20/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction The association between descending pain modulatory system (DPMS) dysfunction and fibromyalgia has been previously described, but more studies are required on its relationship with aberrant functional connectivity (FC) between the motor and prefrontal cortices. Objectives The objective of this cross-sectional observational study was to compare the intra- and interhemispheric FC between the bilateral motor and prefrontal cortices in women with fibromyalgia, comparing responders and nonresponders to the conditioned pain modulation (CPM) test. Methods A cross-sectional sample of 37 women (23 responders and 14 nonresponders to the CPM test) with fibromyalgia diagnosed according to the American College of Rheumatology criteria underwent a standardized clinical assessment and an FC analysis using functional near-infrared spectroscopy. DPMS function was inferred through responses to the CPM test, which were induced by hand immersion in cold water (0–1°C). A multivariate analysis of covariance for main effects between responders and nonresponders was conducted using the diagnosis of multiple psychiatric disorders and the use of opioid and nonopioid analgesics as covariates. In addition, we analyzed the interaction between the CPM test response and the presence of multiple psychiatric diagnoses. Results Nonresponders showed increased FC between the left motor cortex (lMC) and the left prefrontal cortex (lPFC) (t = −2.476, p = 0.01) and right prefrontal cortex (rPFC) (t = −2.363, p = 0.02), even when both were considered as covariates in the regression analysis (lMC–lPFC: β = −0.127, t = −2.425, p = 0.021; lMC–rPFC: β = −0.122, t = −2.222, p = 0.033). Regarding main effects, a significant difference was only observed for lMC–lPFC (p = 0.035). A significant interaction was observed between the psychiatric disorders and nonresponse to the CPM test in lMC−lPFC (β = −0.222, t = −2.275, p = 0.03) and lMC−rPFC (β = −0.211, t = −2.2, p = 0.035). Additionally, a significant interaction was observed between the CPM test and FC in these two region-of-interest combinations, despite the psychiatric diagnoses (lMC−lPFC: β = −0.516, t = −2.447, p = 0.02; lMC−rPFC: β = −0.582, t = −2.805, p = 0.008). Conclusions Higher FC between the lMC and the bilateral PFC may be a neural marker of DPMS dysfunction in women with fibromyalgia, although its interplay with psychiatric diagnoses also seems to influence this association.
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Affiliation(s)
- Álvaro de Oliveira Franco
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Camila Fernanda da Silveira Alves
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Paul Vicuña
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Janete Bandeira
- Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Iraci L. S. Torres
- Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Translational Nucleus: Pain Pharmacology and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, United States of America
| | - Wolnei Caumo
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- * E-mail:
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12
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Grouper H, Löffler M, Flor H, Eisenberg E, Pud D. Increased functional connectivity between limbic brain areas in healthy individuals with high versus low sensitivity to cold pain: A resting state fMRI study. PLoS One 2022; 17:e0267170. [PMID: 35442971 PMCID: PMC9020745 DOI: 10.1371/journal.pone.0267170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The representation of variability in sensitivity to pain by differences in neural connectivity patterns and its association with psychological factors needs further investigation. This study assessed differences in resting-state functional connectivity (rsFC) and its association to cognitive-affective aspects of pain in two groups of healthy subjects with low versus high sensitivity to pain (LSP vs. HSP). We hypothesized that HSP will show stronger connectivity in brain regions involved in the affective-motivational processing of pain and that this higher connectivity would be related to negative affective and cognitive evaluations of pain.
Methods
Forty-eight healthy subjects were allocated to two groups according to their tolerability to cold stimulation (cold pressor test, CPT, 1°C). Group LSP (N = 24) reached the cut-off time of 180±0 sec and group HSP tolerated the CPT for an average of 13±4.8 sec. Heat, cold and mechanical evoked pain were measured, as well as pain-catastrophizing (PCS), depression, anxiety and stress (DASS-21). All subjects underwent resting state fMRI. ROI-to-ROI analysis was performed.
Results
In comparison to the LSP, the HSP had stronger interhemispheric connectivity of the amygdala (p = 0.01) and between the amygdala and nucleus accumbens (NAc) (p = 0.01). Amygdala connectivity was associated with higher pain catastrophizing in the HSP only (p<0.01).
Conclusions
These findings suggest that high sensitivity to pain may be reflected by neural circuits involved in affective and motivational aspects of pain. To what extent this connectivity within limbic brain structures relates to higher alertness and more profound withdrawal behavior to aversive events needs to be further investigated.
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Affiliation(s)
- Hadas Grouper
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- * E-mail:
| | - Martin Löffler
- Medical Faculty Mannheim, Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Herta Flor
- Medical Faculty Mannheim, Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Elon Eisenberg
- The Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
- Institute of Pain Medicine, Haifa, Israel
| | - Dorit Pud
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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13
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de Oliveira PCA, de Araújo TAB, Machado DGDS, Rodrigues AC, Bikson M, Andrade SM, Okano AH, Simplicio H, Pegado R, Morya E. Transcranial Direct Current Stimulation on Parkinson's Disease: Systematic Review and Meta-Analysis. Front Neurol 2022; 12:794784. [PMID: 35082749 PMCID: PMC8785799 DOI: 10.3389/fneur.2021.794784] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/30/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Clinical impact of transcranial direct current stimulation (tDCS) alone for Parkinson's disease (PD) is still a challenge. Thus, there is a need to synthesize available results, analyze methodologically and statistically, and provide evidence to guide tDCS in PD. Objective: Investigate isolated tDCS effect in different brain areas and number of stimulated targets on PD motor symptoms. Methods: A systematic review was carried out up to February 2021, in databases: Cochrane Library, EMBASE, PubMed/MEDLINE, Scopus, and Web of science. Full text articles evaluating effect of active tDCS (anodic or cathodic) vs. sham or control on motor symptoms of PD were included. Results: Ten studies (n = 236) were included in meta-analysis and 25 studies (n = 405) in qualitative synthesis. The most frequently stimulated targets were dorsolateral prefrontal cortex and primary motor cortex. No significant effect was found among single targets on motor outcomes: Unified Parkinson's Disease Rating Scale (UPDRS) III – motor aspects (MD = −0.98%, 95% CI = −10.03 to 8.07, p = 0.83, I2 = 0%), UPDRS IV – dyskinesias (MD = −0.89%, CI 95% = −3.82 to 2.03, p = 0.55, I2 = 0%) and motor fluctuations (MD = −0.67%, CI 95% = −2.45 to 1.11, p = 0.46, I2 = 0%), timed up and go – gait (MD = 0.14%, CI 95% = −0.72 to 0.99, p = 0.75, I2 = 0%), Berg Balance Scale – balance (MD = 0.73%, CI 95% = −1.01 to 2.47, p = 0.41, I2 = 0%). There was no significant effect of single vs. multiple targets in: UPDRS III – motor aspects (MD = 2.05%, CI 95% = −1.96 to 6.06, p = 0.32, I2 = 0%) and gait (SMD = −0.05%, 95% CI = −0.28 to 0.17, p = 0.64, I2 = 0%). Simple univariate meta-regression analysis between treatment dosage and effect size revealed that number of sessions (estimate = −1.7, SE = 1.51, z-score = −1.18, p = 0.2, IC = −4.75 to 1.17) and cumulative time (estimate = −0.07, SE = 0.07, z-score = −0.99, p = 0.31, IC = −0.21 to 0.07) had no significant association. Conclusion: There was no significant tDCS alone short-term effect on motor function, balance, gait, dyskinesias or motor fluctuations in Parkinson's disease, regardless of brain area or targets stimulated.
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Affiliation(s)
- Paloma Cristina Alves de Oliveira
- Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
| | - Thiago Anderson Brito de Araújo
- Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
| | | | - Abner Cardoso Rodrigues
- Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
| | | | - Alexandre Hideki Okano
- Center for Mathematics, Computing and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Hougelle Simplicio
- Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil.,Rehabilitation Center, Anita Garibaldi Center for Education and Health, Santos Dumont Institute, Macaíba, Brazil.,Department of Biomedical Sciences, State University of Rio Grande do Norte, Mossoró, Brazil.,Neuron-Care Unit in Neurosurgery, Hospital Rio Grande, Natal, Brazil
| | - Rodrigo Pegado
- Program in Rehabilitation Science, Program in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Edgard Morya
- Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
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14
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Jiang X, Wang Y, Wan R, Feng B, Zhang Z, Lin Y, Wang Y. The effect of high-definition transcranial direct current stimulation on pain processing in a healthy population: A single-blinded crossover controlled study. Neurosci Lett 2022; 767:136304. [PMID: 34695451 DOI: 10.1016/j.neulet.2021.136304] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 12/28/2022]
Abstract
Transcranial direct current stimulation (tDCS) is increasingly used in pain treatment. tDCS targeting both primary motor cortex (M1) and dorsolateral prefrontal cortex (DLPFC) may modulate the descending pain inhibitory system, however, it remains controversial regarding the optimal stimulation region for pain modulation. Therefore, this study aimed to explore the effects of high-definition anodic stimulation of M1 and DLPFC on conditioned pain modulation (CPM) and pain thresholds and establish a preferred stimulation setting. Twenty-six healthy adults were randomly assigned to M1-tDCS, DLPFC-tDCS, or sham-tDCS groups. During the three sessions, each participant received an active or sham stimulation of 2 mA for 20 min, with at least 3 days' interval between sessions. Quantitative sensory tests were performed to obtain pressure pain threshold (PPT), cold pain threshold (CPT), and CPM before and after the tDCS intervention. Only M1-tDCS significantly increased CPM in healthy individuals compared with sham control (P = 0.004). No statistically significant difference was found in PPT and CPT between tDCS vs. sham control (P > 0.05). Our findings further support the important role of M1 as a target in pain regulation. Further large-scale, multicenter studies in chronic pain populations are needed to validate the alterations of distinct target brain regions related to pain and thus for an optimal target stimulation strategy in pain management.
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Affiliation(s)
- Xue Jiang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China; Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yafei Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ruihan Wan
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Sport Rehabilitation, Shenyang Sport University, Shenyang, China
| | - Beibei Feng
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Orthopedics & Traumatology, The University of Hong Kong, HKSAR, China
| | - Ziping Zhang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Sport Rehabilitation, Shenyang Sport University, Shenyang, China
| | - Yangyang Lin
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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15
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Aloi D, Jalali R, Tilsley P, Miall RC, Fernández-Espejo D. tDCS modulates effective connectivity during motor command following; a potential therapeutic target for disorders of consciousness. Neuroimage 2021; 247:118781. [PMID: 34879252 PMCID: PMC8803542 DOI: 10.1016/j.neuroimage.2021.118781] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/22/2021] [Accepted: 12/04/2021] [Indexed: 12/27/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is attracting increasing interest as a potential therapeutic route for unresponsive patients with prolonged disorders of consciousness (PDOC). However, research to date has had mixed results. Here, we propose a new direction by directly addressing the mechanisms underlying lack of responsiveness in PDOC, and using these to define our targets and the success of our intervention in the healthy brain first. We report 2 experiments that assess whether tDCS to the primary motor cortex (M1-tDCS; Experiment 1) and the cerebellum (cb-tDCS; Experiment 2) administered at rest modulate thalamo-cortical coupling in a subsequent command following task typically used to clinically assess awareness. Both experiments use sham- and polarity-controlled, randomised, double-blind, crossover designs. In Experiment 1, 22 participants received anodal, cathodal, and sham M1-tDCS sessions while in the MRI scanner. A further 22 participants received the same protocol with cb-tDCS in Experiment 2. We used Dynamic Causal Modelling of fMRI to characterise the effects of tDCS on brain activity and dynamics during simple thumb movements in response to command. We found that M1-tDCS increased thalamic excitation and that Cathodal cb-tDCS increased excitatory coupling from thalamus to M1. All these changes were polarity specific. Combined, our experiments demonstrate that tDCS can successfully modulate long range thalamo-cortical dynamics during command following via targeting of cortical regions. This suggests that M1- and cb-tDCS may allow PDOC patients to overcome the motor deficits at the root of their reduced responsiveness, improving their rehabilitation options and quality of life as a result.
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Affiliation(s)
- Davide Aloi
- School of Psychology, University of Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, United Kingdom
| | - Roya Jalali
- School of Psychology, University of Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, United Kingdom
| | - Penelope Tilsley
- School of Psychology, University of Birmingham, United Kingdom; Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France
| | - R Chris Miall
- School of Psychology, University of Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, United Kingdom
| | - Davinia Fernández-Espejo
- School of Psychology, University of Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, United Kingdom.
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16
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Caumo W, Alves RL, Vicuña P, Alves CFDS, Ramalho L, Sanches PRS, Silva DP, Torres ILDS, Fregni F. Impact of bifrontal home-based transcranial direct current stimulation in pain catastrophizing and disability due to pain in fibromyalgia: a randomized, double-blind sham-controlled study. THE JOURNAL OF PAIN 2021; 23:641-656. [PMID: 34785366 DOI: 10.1016/j.jpain.2021.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/05/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022]
Abstract
This randomized, double-blind trial tested the hypothesis that twenty sessions of home-based anodal(a)-transcranial direct current stimulation (tDCS) (2mA for 20 min) bifrontal, with anodal on the left dorsolateral prefrontal cortex (l-DLPFC) would be better than sham-(s)-tDCS to reduce scores on Pain Catastrophizing Scale (PCS) and disability-related to pain (DRP) assessed by the Profile of Chronic Pain: Screen (PCP:S) (primary outcomes). Secondary outcomes were depressive symptoms, sleep quality, heat pain threshold (HPT), heat pain tolerance (HPTo), and serum brain-derived-neurotrophic-factor (BDNF). Forty-eight women with fibromyalgia, 30-65 years-old were randomized into 2:1 groups [a-tDCS (n=32) or s-tDCS (n=16)]. Post hoc analysis revealed that a-tDCS reduced the PCS total scores by 51.38% compared to 26.96% in s-tDCS, and a-tDCS reduced PCP:S total scores by 31.43% compared to 19.15% in s-tDCS. The a-tDCS improved depressive symptoms, sleep quality and increased the HPTo. The delta-value in the serum BDNF (mean post treatment end minus pre-treatment) was conversely correlated with the a-tDCS effect in pain catastrophizing. In contrast, the a-tDCS impact on reducing the DRP at the treatment end was positively associated with a reduction in the serum BDNF and improvement of depressive symptoms, sleep quality and pain catastrophizing symptoms. PERSPECTIVE: Home-based bifrontal tDCS with a-tDCS on the l-DLPFC are associated with a moderate effect size (ES) in the following outcomes: (i) Decreased rumination and magnification of pain catastrophizing. (ii) Improved the disability for daily activities due to fibromyalgia symptoms. Overall, these findings support the feasibility of self-applied home-based tDCS on DLPFC to improve fibromyalgia symptoms.
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Affiliation(s)
- Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, USA; Pain and Palliative Care Service at HCPA, Brazil; Department of Surgery, School of Medicine, UFRGS, Brazil.
| | - Rael Lopes Alves
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | - Paul Vicuña
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | - Camila Fernanda da Silveira Alves
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | - Leticia Ramalho
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | | | | | | | - Felipe Fregni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, USA; School of Medicine, UFRGS; Laboratorio de Farmacologia da Dor e Neuromodulação: Investigacoes Pre-clinicas, Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
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Parker T, Raghu A, Huang Y, Gillies MJ, FitzGerald JJ, Aziz T, Green AL. Paired Acute Invasive/Non-invasive Stimulation (PAINS) study: A phase I/II randomized, sham-controlled crossover trial in chronic neuropathic pain. Brain Stimul 2021; 14:1576-1585. [PMID: 34673258 DOI: 10.1016/j.brs.2021.10.384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/09/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Dorsal root ganglion (DRG) stimulation, an invasive method of neuromodulation, and transcranial direct current stimulation (tDCS), a non-invasive method of altering cortical excitability, have both proven effective in relieving chronic pain. OBJECTIVE We employed a randomized, sham-controlled crossover study design to investigate whether single-session tDCS would have an additive therapeutic effect alongside DRG stimulation (DRGS) in the treatment of chronic pain. METHODS Sixteen neuropathic pain patients who were previously implanted with DRG stimulators were recruited. Baseline pain scores were established with DRGS-OFF. Pain scores were then recorded with DRGS-ON, after paired sham tDCS stimulation, and after paired active anodal tDCS (a-tDCS) stimulation. For active tDCS, patients were randomized to 'MEG (magnetoencephalography) localized' tDCS or contralateral motor cortex (M1) tDCS for 30 min. EEG recordings and evaluations of tDCS adverse effects were also collected. RESULTS All participants reported the interventions to be tolerable with no significant adverse effects during the session. Paired DRGS/active tDCS resulted in a significant reduction in pain scores compared to paired DRGS-ON/sham tDCS or DRGS alone. There was no difference in the additive effect of M1 vs. MEG-localized tDCS. Significant augmentation of beta activity was observed between DRGS-OFF and DRGS-ON conditions, as well as between paired DRGS-ON/sham tDCS and paired DRGS-ON/active tDCS. CONCLUSION Our results indicate that a single session of tDCS alongside DRGS is safe and can significantly reduce pain acutely in neuropathic pain patients. Paired invasive/non-invasive neuromodulation is a promising new treatment strategy for pain management and should be evaluated further to assess long-term benefits.
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Affiliation(s)
- Tariq Parker
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom; Neurosurgery Department, Massachusetts General Hospital, Boston, MA, USA.
| | - Ashley Raghu
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Yongzhi Huang
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom; Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Martin J Gillies
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - James J FitzGerald
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Tipu Aziz
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Alexander L Green
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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18
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Kandić M, Moliadze V, Andoh J, Flor H, Nees F. Brain Circuits Involved in the Development of Chronic Musculoskeletal Pain: Evidence From Non-invasive Brain Stimulation. Front Neurol 2021; 12:732034. [PMID: 34531819 PMCID: PMC8438114 DOI: 10.3389/fneur.2021.732034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/06/2021] [Indexed: 12/03/2022] Open
Abstract
It has been well-documented that the brain changes in states of chronic pain. Less is known about changes in the brain that predict the transition from acute to chronic pain. Evidence from neuroimaging studies suggests a shift from brain regions involved in nociceptive processing to corticostriatal brain regions that are instrumental in the processing of reward and emotional learning in the transition to the chronic state. In addition, dysfunction in descending pain modulatory circuits encompassing the periaqueductal gray and the rostral anterior cingulate cortex may also be a key risk factor for pain chronicity. Although longitudinal imaging studies have revealed potential predictors of pain chronicity, their causal role has not yet been determined. Here we review evidence from studies that involve non-invasive brain stimulation to elucidate to what extent they may help to elucidate the brain circuits involved in pain chronicity. Especially, we focus on studies using non-invasive brain stimulation techniques [e.g., transcranial magnetic stimulation (TMS), particularly its repetitive form (rTMS), transcranial alternating current stimulation (tACS), and transcranial direct current stimulation (tDCS)] in the context of musculoskeletal pain chronicity. We focus on the role of the motor cortex because of its known contribution to sensory components of pain via thalamic inhibition, and the role of the dorsolateral prefrontal cortex because of its role on cognitive and affective processing of pain. We will also discuss findings from studies using experimentally induced prolonged pain and studies implicating the DLPFC, which may shed light on the earliest transition phase to chronicity. We propose that combined brain stimulation and imaging studies might further advance mechanistic models of the chronicity process and involved brain circuits. Implications and challenges for translating the research on mechanistic models of the development of chronic pain to clinical practice will also be addressed.
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Affiliation(s)
- Mina Kandić
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Vera Moliadze
- Institute of Medical Psychology and Medical Sociology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Jamila Andoh
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frauke Nees
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Institute of Medical Psychology and Medical Sociology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
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19
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Sunagawa T, Ueda A, Kurumadani H, Zehry HI, Date S, Ishii Y. Transcranial direct current stimulation reduces ischemia-induced sensory disturbance in the hands of healthy subjects. Muscle Nerve 2021; 64:610-613. [PMID: 34378200 DOI: 10.1002/mus.27394] [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: 02/04/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION/AIMS The treatment of entrapment neuropathies, such as carpal tunnel syndrome or cubital tunnel syndrome, has significant challenges that have yet to be solved. To a large extent, the success of the treatment of peripheral nerve damage is dependent on brain plasticity during the recovery process. Recently, noninvasive brain stimulation procedures, such as transcranial direct current stimulation (tDCS), to modulate brain activity have been developed. This study aimed to determine whether tDCS can improve artificially induced ischemic sensory disturbances in the finger. METHODS Ten right-handed, healthy volunteers, with an average age of 25.5 years, participated in this study. A rubber bandage at the base of the right index finger was used to induce a regional sensory disturbance for 30 minutes. An anodal tDCS was applied over their left M1 area 15 minutes into the session. The current perception threshold (CPT) in the index and little finger pad was evaluated using the PainVision system and used as a measure of the sensory threshold. RESULTS In the index finger, the CPT increased significantly with time, a finding that was absent after tDCS application. DISCUSSION It has been reported that anodal tDCS over M1 primarily modulates the functional connectivity of sensory networks, and our findings demonstrate that it improved ischemia-induced sensory disturbances. Modulating the central nervous system using tDCS represents a potential avenue for treating entrapment neuropathies.
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Affiliation(s)
- Toru Sunagawa
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Ueda
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Kurumadani
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hanan Ibrahim Zehry
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shota Date
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yosuke Ishii
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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20
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Cerrahoğlu Şirin T, Aksu S, Hasirci Bayir BR, Ulukan Ç, Karamürsel S, Kurt A, Baykan B. Is Allodynia a Determinant Factor in the Effectiveness of Transcranial Direct Current Stimulation in the Prophylaxis of Migraine? Neuromodulation 2021; 24:899-909. [PMID: 34058041 DOI: 10.1111/ner.13409] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/08/2021] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Allodynia, the clinical marker of central sensitization, affects even simple daily living activities and increases the tendency for migraine to be more resistant to treatment and have a chronic course. Migraine that impairs quality of life can often be treated with variable pharmaceutical agents, but with various side effects. Transcranial direct current stimulation (tDCS) is a potential alternative treatment for migraine prophylaxis. MATERIALS AND METHODS Seventy-seven patients diagnosed with migraine (48 with allodynia and 29 without allodynia) were included in the study. Randomly, 41 of the 77 patients received sham stimulation and 36 patients underwent three sessions of anodal left primary motor cortex stimulation for 2 mA, 20 min. Migraine attack characteristics (frequency, severity, and duration) and analgesic drug use were followed with headache diaries for one month after the stimulation. RESULTS After tDCS, migraine attack frequency (p = 0.021), the number of headache days (p = 0.005), duration of attacks (p = 0.008), and symptomatic analgesic drug use (p = 0.007) decreased in patients receiving active tDCS, compared to the sham group. The therapeutic gain of tDCS was calculated as 44% (95% confidence interval [CI]: 22-60%) for headache days and 76% (95% CI: 55-86) for headache duration. Response to tDCS treatment was higher in patients without allodynia (60% vs. 24%; p = 0.028) and allodynia came out as an independent predictor of response to tDCS with logistic regression analysis. Side effects were rare and similar to the sham group. CONCLUSIONS tDCS is a safe, efficacious, and fast method for migraine prophylaxis. However, the administration of tDCS before allodynia occurs, that is, before central sensitization develops, will provide increased responsiveness to the treatment. SIGNIFICANCE tDCS is more effective before the development of allodynia, but it also improves the quality of life even after the development of allodynia.
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Affiliation(s)
- Tuba Cerrahoğlu Şirin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Neuroscience, Graduate School of Health Sciences, Istanbul University, Istanbul, Turkey
| | - Serkan Aksu
- Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Buse Rahime Hasirci Bayir
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Neuroscience, Graduate School of Health Sciences, Istanbul University, Istanbul, Turkey
| | - Çağrı Ulukan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sacit Karamürsel
- Department of Physiology, School of Medicine, Koc Universitesi, Istanbul, Turkey
| | - Adnan Kurt
- Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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21
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fMRI and transcranial electrical stimulation (tES): A systematic review of parameter space and outcomes. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110149. [PMID: 33096158 DOI: 10.1016/j.pnpbp.2020.110149] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/12/2020] [Accepted: 10/17/2020] [Indexed: 12/12/2022]
Abstract
The combination of non-invasive brain stimulation interventions with human brain mapping methods have supported research beyond correlational associations between brain activity and behavior. Functional MRI (fMRI) partnered with transcranial electrical stimulation (tES) methods, i.e., transcranial direct current (tDCS), transcranial alternating current (tACS), and transcranial random noise (tRNS) stimulation, explore the neuromodulatory effects of tES in the targeted brain regions and their interconnected networks and provide opportunities for individualized interventions. Advances in the field of tES-fMRI can be hampered by the methodological variability between studies that confounds comparability/replicability. In order to explore variability in the tES-fMRI methodological parameter space (MPS), we conducted a systematic review of 222 tES-fMRI experiments (181 tDCS, 39 tACS and 2 tRNS) published before February 1, 2019, and suggested a framework to systematically report main elements of MPS across studies. Publications dedicated to tRNS-fMRI were not considered in this systematic review. We have organized main findings in terms of fMRI modulation by tES. tES modulates activation and connectivity beyond the stimulated areas particularly with prefrontal stimulation. There were no two studies with the same MPS to replicate findings. We discuss how to harmonize the MPS to promote replication in future studies.
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22
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Effectiveness of Unihemispheric Concurrent Dual-Site Stimulation over M1 and Dorsolateral Prefrontal Cortex Stimulation on Pain Processing: A Triple Blind Cross-Over Control Trial. Brain Sci 2021; 11:brainsci11020188. [PMID: 33557028 PMCID: PMC7913659 DOI: 10.3390/brainsci11020188] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Transcranial direct current stimulation (tDCS) of the motor cortex (M1) produces short-term inhibition of pain. Unihemispheric concurrent dual-site tDCS (UHCDS-tDCS) over the M1 and dorsolateral prefrontal cortex (DLPFC) has greater effects on cortical excitability than when applied alone, although its effect on pain is unknown. The aim of this study was to test if anodal UHCDS-tDCS over the M1 and DLPFC in healthy participants could potentiate conditioned pain modulation (CPM) and diminish pain temporal summation (TS). Methods: Thirty participants were randomized to receive a sequence of UHCDS-tDCS, M1-tDCS and sham-tDCS. A 20 min 0.1 mA/cm2 anodal or sham-tDCS intervention was applied to each participant during three test sessions, according to a triple-blind cross-over trial design. For the assessment of pain processing before and after tDCS intervention, the following tests were performed: tourniquet conditioned pain modulation (CPM), pressure pain temporal summation (TS), pressure pain thresholds (PPTs), pressure pain tolerance, mechanosensitivity and cold hyperalgesia. Motor function before and after tDCS intervention was assessed with a dynamometer to measure maximal isometric grip strength. Results: No statistically significant differences were found between groups for CPM, pressure pain TS, PPT, pressure pain tolerance, neural mechanosensitivity, cold hyperalgesia or grip strength (p > 0.05). Conclusions: Neither UHCDS-tDCS nor M1-tDCS facilitated CPM or inhibited TS in healthy subjects following one intervention session.
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23
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Tanaka T, Isomura Y, Kobayashi K, Hanakawa T, Tanaka S, Honda M. Electrophysiological Effects of Transcranial Direct Current Stimulation on Neural Activity in the Rat Motor Cortex. Front Neurosci 2020; 14:495. [PMID: 32714126 PMCID: PMC7340144 DOI: 10.3389/fnins.2020.00495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 04/20/2020] [Indexed: 02/04/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive technique that modulates the neuronal membrane potential. We have previously documented a sustainable increase in extracellular dopamine levels in the rat striatum of cathodal tDCS, suggesting that cathodal tDCS enhances the neuronal excitability of the cortex. In the present study, we investigated changes in neuronal activity in the cerebral cortex induced by tDCS at the point beneath the stimulus electrode in anesthetized rats in vivo. Multiunit recordings were performed to examine changes in neuronal activity before and after the application of tDCS. In the cathodal tDCS group, multiunit activity (indicating the collective firing rate of recorded neuronal populations) increased in the cerebral cortex. Both anodal and cathodal tDCS increased the firing rate of isolated single units in the cerebral cortex. Significant differences in activity were observed immediately following stimulation and persisted for more than an hour after stimulation. The primary finding of this study was that both anodal and cathodal tDCS increased in vivo neuronal activity in the rat cerebral cortex underneath the stimulus electrode.
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Affiliation(s)
- Tomoko Tanaka
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Setagaya, Japan.,Department of Information Medicine, National Institute of Neuroscience, National Centre of Neurology and Psychiatry, Kodaira, Japan
| | - Yoshikazu Isomura
- Physiology and Cell Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Japan
| | - Kazuto Kobayashi
- Department of Molecular Genetics, Institute of Biomedical Sciences, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takashi Hanakawa
- Department of Information Medicine, National Institute of Neuroscience, National Centre of Neurology and Psychiatry, Kodaira, Japan.,Department of Advanced Neuroimaging, Integrative Brain Imaging Centre, National Centre of Neurology and Psychiatry, Kodaira, Japan
| | - Satoshi Tanaka
- Laboratory of Psychology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Manabu Honda
- Department of Information Medicine, National Institute of Neuroscience, National Centre of Neurology and Psychiatry, Kodaira, Japan
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24
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Morya E, Monte-Silva K, Bikson M, Esmaeilpour Z, Biazoli CE, Fonseca A, Bocci T, Farzan F, Chatterjee R, Hausdorff JM, da Silva Machado DG, Brunoni AR, Mezger E, Moscaleski LA, Pegado R, Sato JR, Caetano MS, Sá KN, Tanaka C, Li LM, Baptista AF, Okano AH. Beyond the target area: an integrative view of tDCS-induced motor cortex modulation in patients and athletes. J Neuroeng Rehabil 2019; 16:141. [PMID: 31730494 PMCID: PMC6858746 DOI: 10.1186/s12984-019-0581-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) is a non-invasive technique used to modulate neural tissue. Neuromodulation apparently improves cognitive functions in several neurologic diseases treatment and sports performance. In this study, we present a comprehensive, integrative review of tDCS for motor rehabilitation and motor learning in healthy individuals, athletes and multiple neurologic and neuropsychiatric conditions. We also report on neuromodulation mechanisms, main applications, current knowledge including areas such as language, embodied cognition, functional and social aspects, and future directions. We present the use and perspectives of new developments in tDCS technology, namely high-definition tDCS (HD-tDCS) which promises to overcome one of the main tDCS limitation (i.e., low focality) and its application for neurological disease, pain relief, and motor learning/rehabilitation. Finally, we provided information regarding the Transcutaneous Spinal Direct Current Stimulation (tsDCS) in clinical applications, Cerebellar tDCS (ctDCS) and its influence on motor learning, and TMS combined with electroencephalography (EEG) as a tool to evaluate tDCS effects on brain function.
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Affiliation(s)
- Edgard Morya
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Rio Grande do Norte Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Kátia Monte-Silva
- Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Zeinab Esmaeilpour
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Claudinei Eduardo Biazoli
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Andre Fonseca
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Tommaso Bocci
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, International Medical School, University of Milan, Milan, Italy
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Raaj Chatterjee
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Jeffrey M. Hausdorff
- Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Eva Mezger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Luciane Aparecida Moscaleski
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Rodrigo Pegado
- Graduate Program in Rehabilitation Science, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte Brazil
| | - João Ricardo Sato
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Marcelo Salvador Caetano
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Kátia Nunes Sá
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
| | - Clarice Tanaka
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Li Min Li
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Abrahão Fontes Baptista
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Alexandre Hideki Okano
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Graduate Program in Physical Education. State University of Londrina, Londrina, Paraná, Brazil
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25
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Effect of one session of tDCS on the severity of pain in women with chronic pelvic pain. J Bodyw Mov Ther 2019; 23:678-682. [PMID: 31563388 DOI: 10.1016/j.jbmt.2017.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/25/2017] [Accepted: 12/17/2017] [Indexed: 12/18/2022]
Abstract
AIM The present study aimed to investigate the effects of tDCS on pain score in women with Chronic Pelvic Pain (CPP). MATERIALS & METHODS A total of 16 women with CPP participated in the present double-blind sham-controlled cross-over study. Each participant received a 20-min 0.3 MA of trans Cranial Direct Stimulation (tDCS) with a current density of 0.1 mA/cm2. In addition to the pain intensity, the Quality of Life (QOL), disability, and depression statuses were assessed prior to and one week after the treatment. Shapiro-Wilks goodness-of-fit test for normality, dependent t-Test, and Wilcoxon Signed- Rank Test were used for data analysis. Values of p < .05 were considered statistically significant. FINDINGS Active tDCS treatment was effective in the reduction of pain (p = .0001), improving QOL (208.938 > 193.313, P = .025), and the disability (22.375 < 30.375, P = .025). The results showed no effect of active or sham treatment on the depression (p ≥ .05). CONCLUSION The positive effects of active tDCS on CPP suggest the need to study the effect of this method on other types of chronic pain.
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Brietzke AP, Zortea M, Carvalho F, Sanches PRS, Silva DPJ, Torres ILDS, Fregni F, Caumo W. Large Treatment Effect With Extended Home-Based Transcranial Direct Current Stimulation Over Dorsolateral Prefrontal Cortex in Fibromyalgia: A Proof of Concept Sham-Randomized Clinical Study. THE JOURNAL OF PAIN 2019; 21:212-224. [PMID: 31356985 DOI: 10.1016/j.jpain.2019.06.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/23/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
This randomized, double-blind controlled trial tested the hypothesis that 60 sessions of home-based anodal (a)-transcranial direct current stimulation (tDCS) over dorsolateral prefrontal cortex (DLPFC) would be better than home-based sham-tDCS to improve the widespread pain and the disability-related to pain. The anodal-tDCS (2 mA for 30 minutes) over the left DLPFC was self-administered with a specially developed device following in-person training. Twenty women, 18 to 65 years old were randomized into 2 groups [active-(a)-tDCS (n = 10) or sham-(s)-tDCS (n = 10)]. Post hoc analysis revealed that after the first 20 sessions of a-tDCS, the cumulative pain scores reduced by 45.65% [7.25 (1.43) vs 3.94 (1.14), active vs sham tDCS, respectively]. After 60 sessions, during the 12-week assessment, pain scores reduced by 62.06% in the actively group [visual analogue scale reduction, 7.25 (1.43) to 2.75 (.85)] compared to 24.92% in the s-tDCS group, [mean (SD) 7.10 (1.81) vs 5.33 (.90)], respectively. It reduced the risk for analgesic use in 55%. Higher serum levels of the brain-derived neurotrophic factor predicted higher decreases on the pain scores across of treatment. PERSPECTIVE: These findings bring 3 important insights: 1) show that an extended period of treatment (60 sessions, to date the largest number of tDCS sessions tested) for fibromyalgia induces large pain decreases (a large effect size of 1.59) and 2) support the feasibility of home-based tDCS as a method of intervention; 3) provide additional data on DLPFC target for the treatment of fibromyalgia. Finally, our findings also highlight that brain-derived neurotrophic factor to index neuroplasticity may be a valuable predictor of the tDCS effect on pain scores decreases across the treatment.
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Affiliation(s)
- Aline P Brietzke
- 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
| | - Maxciel Zortea
- 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
| | - Fabiana Carvalho
- 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
| | | | | | - Iraci Lucena da Silva Torres
- 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; Laboratory of Biomedical Engineering at HCPA, Porto Alegre, Brazil; Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, Massachusetts; Pain and Palliative Care Service at HCPA, Porto Alegre, Brazil; Department of Surgery, School of Medicine, UFRGS, Porto Alegre, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - 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; Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, Massachusetts; Pain and Palliative Care Service at HCPA, Porto Alegre, Brazil; Department of Surgery, School of Medicine, UFRGS, Porto Alegre, Brazil.
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27
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Bandeira JS, Antunes LDC, Soldatelli MD, Sato JR, Fregni F, Caumo W. Functional Spectroscopy Mapping of Pain Processing Cortical Areas During Non-painful Peripheral Electrical Stimulation of the Accessory Spinal Nerve. Front Hum Neurosci 2019; 13:200. [PMID: 31263406 PMCID: PMC6585570 DOI: 10.3389/fnhum.2019.00200] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 05/28/2019] [Indexed: 01/30/2023] Open
Abstract
Peripheral electrical stimulation (PES), which encompasses several techniques with heterogeneous physiological responses, has shown in some cases remarkable outcomes for pain treatment and clinical rehabilitation. However, results are still mixed, mainly because there is a lack of understanding regarding its neural mechanisms of action. In this study, we aimed to assess its effects by measuring cortical activation as indexed by functional near infrared spectroscopy (fNIRS). fNIRS is a functional optical imaging method to evaluate hemodynamic changes in oxygenated (HbO) and de-oxygenated (HbR) blood hemoglobin concentrations in cortical capillary networks that can be related to cortical activity. We hypothesized that non-painful PES of accessory spinal nerve (ASN) can promote cortical activation of sensorimotor cortex (SMC) and dorsolateral prefrontal cortex (DLPFC) pain processing cortical areas. Fifteen healthy volunteers received both active and sham ASN electrical stimulation in a crossover study. The hemodynamic cortical response to unilateral right ASN burst electrical stimulation with 10 Hz was measured by a 40-channel fNIRS system. The effect of ASN electrical stimulation over HbO concentration in cortical areas of interest (CAI) was observed through the activation of right-DLPFC (p = 0.025) and left-SMC (p = 0.042) in the active group but not in sham group. Regarding left-DLPFC (p = 0.610) and right-SMC (p = 0.174) there was no statistical difference between groups. As in non-invasive brain stimulation (NIBS) top-down modulation, bottom-up electrical stimulation to the ASN seems to activate the same critical cortical areas on pain pathways related to sensory-discriminative and affective-motivational pain dimensions. These results provide additional mechanistic evidence to develop and optimize the use of peripheral nerve electrical stimulation as a neuromodulatory tool (NCT 03295370— www.clinicaltrials.gov).
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Affiliation(s)
- Janete Shatkoski Bandeira
- Laboratory of Pain and Neuromodulation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Luciana da Conceição Antunes
- Department of Nutrition, Health Science Center, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | | | - João Ricardo Sato
- Department of Mathematics and Statistics, Universidade Federal do ABC, Santo André, Brazil
| | - Felipe Fregni
- Physical Medicine & Rehabilitation, Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Wolnei Caumo
- Laboratory of Pain and Neuromodulation, Department of Pain and Anesthesia in Surgery, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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28
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Abstract
Changes in brain function in chronic pain have been studied using paradigms that deliver acute pain-eliciting stimuli or assess the brain at rest. Although motor disability accompanies many chronic pain conditions, few studies have directly assessed brain activity during motor function in individuals with chronic pain. Using chronic jaw pain as a model, we assessed brain activity during a precisely controlled grip force task and during a precisely controlled pain-eliciting stimulus on the forearm. We used multivariate analyses to identify regions across the brain whose activity together best separated the groups. We report 2 novel findings. First, although the parameters of grip force production were similar between the groups, the functional activity in regions including the prefrontal cortex, insula, and thalamus best separated the groups. Second, although stimulus intensity and pain perception were similar between the groups, functional activity in brain regions including the dorsal lateral prefrontal cortex, rostral ventral premotor cortex, and inferior parietal lobule best separated the groups. Our observations suggest that chronic jaw pain is associated with changes in how the brain processes motor and pain-related information even when the effector producing the force or experiencing the pain-eliciting stimulus is distant from the jaw. We also demonstrate that motor tasks and multivariate analyses offer alternative approaches for studying brain function in chronic jaw pain.
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29
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Viganò A, Toscano M, Puledda F, Di Piero V. Treating Chronic Migraine With Neuromodulation: The Role of Neurophysiological Abnormalities and Maladaptive Plasticity. Front Pharmacol 2019; 10:32. [PMID: 30804782 PMCID: PMC6370938 DOI: 10.3389/fphar.2019.00032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/14/2019] [Indexed: 12/20/2022] Open
Abstract
Chronic migraine (CM) is the most disabling form of migraine, because pharmacological treatments have low efficacy and cumbersome side effects. New evidence has shown that migraine is primarily a disorder of brain plasticity and migraine chronification depends on a maladaptive process favoring the development of a brain state of hyperexcitability. Due to the ability to induce plastic changes in the brain, researchers started to look at Non-Invasive Brain Stimulation (NIBS) as a possible therapeutic option in migraine field. On one side, NIBS techniques induce changes of neural plasticity that outlast the period of the stimulation (a fundamental prerequisite of a prophylactic migraine treatment, concurrently they allow targeting neurophysiological abnormalities that contribute to the transition from episodic to CM. The action may thus influence not only the cortex but also brainstem and diencephalic structures. Plus, NIBS is not burdened by serious medication side effects and drug–drug interactions. Although the majority of the studies reported somewhat beneficial effects in migraine patients, no standard intervention has been defined. This may be due to methodological differences regarding the used techniques (e.g., transcranial magnetic stimulation, transcranial direct current stimulation), the brain regions chosen as targets, and the stimulation types (e.g., the use of inhibitory and excitatory stimulations on the basis of opposite rationales), and an intrinsic variability of stimulation effect. Hence, it is difficult to draw a conclusion on the real effect of neuromodulation in migraine. In this article, we first will review the definition and mechanisms of brain plasticity, some neurophysiological hallmarks of migraine, and migraine chronification-related (dys)plasticity. Secondly, we will review available results from therapeutic and physiological studies using neuromodulation in CM. Lastly we will discuss the results obtained in these preventive trials in the light of a possible effect on brain plasticity.
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Affiliation(s)
- Alessandro Viganò
- Headache Research Centre and Neurocritical Care Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,Molecular and Cellular Networks Lab, Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Toscano
- Headache Research Centre and Neurocritical Care Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Rome, Italy
| | - Francesca Puledda
- Headache Group, Department of Basic and Clinical Neuroscience, King's College Hospital, King's College London, London, United Kingdom
| | - Vittorio Di Piero
- Headache Research Centre and Neurocritical Care Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,University Consortium for Adaptive Disorders and Head Pain - UCADH, Pavia, Italy
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30
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Pini L, Manenti R, Cotelli M, Pizzini FB, Frisoni GB, Pievani M. Non-Invasive Brain Stimulation in Dementia: A Complex Network Story. NEURODEGENER DIS 2019; 18:281-301. [PMID: 30695786 DOI: 10.1159/000495945] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/30/2018] [Indexed: 11/19/2022] Open
Abstract
Non-invasive brain stimulation (NIBS) is emerging as a promising rehabilitation tool for a number of neurodegenerative diseases. However, the therapeutic mechanisms of NIBS are not completely understood. In this review, we will summarize NIBS results in the context of brain imaging studies of functional connectivity and metabolites to gain insight into the possible mechanisms underlying recovery. We will briefly discuss how the clinical manifestations of common neurodegenerative disorders may be related with aberrant connectivity within large-scale neural networks. We will then focus on recent studies combining resting-state functional magnetic resonance imaging with NIBS to delineate how stimulation of different brain regions induce complex network modifications, both at the local and distal level. Moreover, we will review studies combining magnetic resonance spectroscopy and NIBS to investigate how microscale changes are related to modifications of large-scale networks. Finally, we will re-examine previous NIBS studies in dementia in light of this network perspective. A better understanding of NIBS impact on the functionality of large-scale brain networks may be useful to design beneficial treatments for neurodegenerative disorders.
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Affiliation(s)
- Lorenzo Pini
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Rosa Manenti
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Francesca B Pizzini
- Neuroradiology, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - Giovanni B Frisoni
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,University Hospitals and University of Geneva, Geneva, Switzerland
| | - Michela Pievani
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy,
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31
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Li LM, Violante IR, Leech R, Hampshire A, Opitz A, McArthur D, Carmichael DW, Sharp DJ. Cognitive enhancement with Salience Network electrical stimulation is influenced by network structural connectivity. Neuroimage 2019; 185:425-433. [PMID: 30385222 PMCID: PMC6299257 DOI: 10.1016/j.neuroimage.2018.10.069] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/11/2018] [Accepted: 10/26/2018] [Indexed: 12/13/2022] Open
Abstract
The Salience Network (SN) and its interactions are important for cognitive control. We have previously shown that structural damage to the SN is associated with abnormal functional connectivity between the SN and Default Mode Network (DMN), abnormal DMN deactivation, and impaired response inhibition, which is an important aspect of cognitive control. This suggests that stimulating the SN might enhance cognitive control. Here, we tested whether non-invasive transcranial direct current stimulation (TDCS) could be used to modulate activity within the SN and enhance cognitive control. TDCS was applied to the right inferior frontal gyrus/anterior insula cortex during performance of the Stop Signal Task (SST) and concurrent functional (f)MRI. Anodal TDCS improved response inhibition. Furthermore, stratification of participants based on SN structural connectivity showed that it was an important influence on both behavioural and physiological responses to anodal TDCS. Participants with high fractional anisotropy within the SN showed improved SST performance and increased activation of the SN with anodal TDCS, whilst those with low fractional anisotropy within the SN did not. Cathodal stimulation of the SN produced activation of the right caudate, an effect which was not modulated by SN structural connectivity. Our results show that stimulation targeted to the SN can improve response inhibition, supporting the causal influence of this network on cognitive control and confirming it as a target to produce cognitive enhancement. Our results also highlight the importance of structural connectivity as a modulator of network to TDCS, which should guide the design and interpretation of future stimulation studies.
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Affiliation(s)
- Lucia M Li
- Computational, Cognitive and Clinical Imaging Lab, Division of Brain Sciences, Department of Medicine, Imperial College London, W12 0NN, UK
| | | | - Rob Leech
- Centre for Neuroimaging Science, Denmark Hill, SE5 8AF, UK
| | - Adam Hampshire
- Computational, Cognitive and Clinical Imaging Lab, Division of Brain Sciences, Department of Medicine, Imperial College London, W12 0NN, UK
| | - Alexander Opitz
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - David McArthur
- David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA
| | | | - David J Sharp
- Computational, Cognitive and Clinical Imaging Lab, Division of Brain Sciences, Department of Medicine, Imperial College London, W12 0NN, UK.
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32
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Chan S, Bota R. Personalized TMS: role of RNA genotyping. Ment Illn 2019; 11:8-15. [PMID: 32742620 PMCID: PMC7364573 DOI: 10.1108/mij-10-2019-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Noninvasive brain stimulation (NIBS) such a transcranial magnetic stimulation, intermittent theta burst stimulation, transcranial direct current stimulation and electroconvulsive therapy have emerged as an efficacious and well-tolerated therapy for treatment-resistant psychiatric disorders. While novel NIBS techniques are an exciting addition to the current repertoire of neuropsychiatric therapies, their success is somewhat limited by the wide range of treatment responses seen among treated patients. Design/methodology/approach In this study, the authors will review the studies on relevant genetic polymorphisms and discuss the role of RNA genotyping in personalizing NIBS. Findings Genome studies have revealed several genetic polymorphisms that may contribute for the heterogeneity of treatment response to NIBS where the presence of certain single nucleotide polymorphisms (SNPs) are associated with responders versus nonresponders. Originality/value Historically, mental illnesses have been arguably some of the most challenging disorders to study and to treat because of the degree of biological variability across affected individuals, the role of genetic and epigenetic modifications, the diversity of clinical symptomatology and presentations and the interplay with environmental factors. In lieu of these challenges, there has been a push for personalized medicine in psychiatry that aims to optimize treatment response based on one's unique characteristics.
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Affiliation(s)
- Shawna Chan
- University of California Irvine, Irvine, California, USA
| | - Robert Bota
- University of California Irvine, Irvine, California, USA
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33
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Li LM, Violante IR, Leech R, Ross E, Hampshire A, Opitz A, Rothwell JC, Carmichael DW, Sharp DJ. Brain state and polarity dependent modulation of brain networks by transcranial direct current stimulation. Hum Brain Mapp 2018; 40:904-915. [PMID: 30378206 PMCID: PMC6387619 DOI: 10.1002/hbm.24420] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/04/2018] [Accepted: 10/03/2018] [Indexed: 01/03/2023] Open
Abstract
Despite its widespread use in cognitive studies, there is still limited understanding of whether and how transcranial direct current stimulation (tDCS) modulates brain network function. To clarify its physiological effects, we assessed brain network function using functional magnetic resonance imaging (fMRI) simultaneously acquired during tDCS stimulation. Cognitive state was manipulated by having subjects perform a Choice Reaction Task or being at “rest.” A novel factorial design was used to assess the effects of brain state and polarity. Anodal and cathodal tDCS were applied to the right inferior frontal gyrus (rIFG), a region involved in controlling activity large‐scale intrinsic connectivity networks during switches of cognitive state. tDCS produced widespread modulation of brain activity in a polarity and brain state dependent manner. In the absence of task, the main effect of tDCS was to accentuate default mode network (DMN) activation and salience network (SN) deactivation. In contrast, during task performance, tDCS increased SN activation. In the absence of task, the main effect of anodal tDCS was more pronounced, whereas cathodal tDCS had a greater effect during task performance. Cathodal tDCS also accentuated the within‐DMN connectivity associated with task performance. There were minimal main effects of stimulation on network connectivity. These results demonstrate that rIFG tDCS can modulate the activity and functional connectivity of large‐scale brain networks involved in cognitive function, in a brain state and polarity dependent manner. This study provides an important insight into mechanisms by which tDCS may modulate cognitive function, and also has implications for the design of future stimulation studies.
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Affiliation(s)
- Lucia M Li
- Computational, Cognitive, and Clinical Imaging Lab, Division of Brain Sciences, Department of Medicine, Imperial College, London, UK
| | - Ines R Violante
- Computational, Cognitive, and Clinical Imaging Lab, Division of Brain Sciences, Department of Medicine, Imperial College, London, UK.,Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, London, UK.,School of Psychology, University of Surrey, Guildford, UK
| | - Rob Leech
- Centre for Neuroimaging Science, Kings College London, UK
| | - Ewan Ross
- Computational, Cognitive, and Clinical Imaging Lab, Division of Brain Sciences, Department of Medicine, Imperial College, London, UK
| | - Adam Hampshire
- Computational, Cognitive, and Clinical Imaging Lab, Division of Brain Sciences, Department of Medicine, Imperial College, London, UK
| | - Alexander Opitz
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, London, UK
| | - David W Carmichael
- Centre for Neuroimaging Science, Kings College London, UK.,Department of Biomedical Engineering, Kings College London, UK
| | - David J Sharp
- Computational, Cognitive, and Clinical Imaging Lab, Division of Brain Sciences, Department of Medicine, Imperial College, London, UK
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34
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Weizman L, Dayan L, Brill S, Nahman-Averbuch H, Hendler T, Jacob G, Sharon H. Cannabis analgesia in chronic neuropathic pain is associated with altered brain connectivity. Neurology 2018; 91:e1285-e1294. [PMID: 30185448 DOI: 10.1212/wnl.0000000000006293] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/29/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To characterize the functional brain changes involved in δ-9-tetrahydrocannabinol (THC) modulation of chronic neuropathic pain. METHODS Fifteen patients with chronic radicular neuropathic pain participated in a randomized, double-blind, placebo-controlled trial employing a counterbalanced, within-subjects design. Pain assessments and functional resting state brain scans were performed at baseline and after sublingual THC administration. We examined functional connectivity of the anterior cingulate cortex (ACC) and pain-related network dynamics using graph theory measures. RESULTS THC significantly reduced patients' pain compared to placebo. THC-induced analgesia was correlated with a reduction in functional connectivity between the anterior cingulate cortex (ACC) and the sensorimotor cortex. Moreover, the degree of reduction was predictive of the response to THC. Graph theory analyses of local measures demonstrated reduction in network connectivity in areas involved in pain processing, and specifically in the dorsolateral prefrontal cortex (DLPFC), which were correlated with individual pain reduction. CONCLUSION These results suggest that the ACC and DLPFC, 2 major cognitive-emotional modulation areas, and their connections to somatosensory areas, are functionally involved in the analgesic effect of THC in chronic pain. This effect may therefore be mediated through induction of functional disconnection between regulatory high-order affective regions and the sensorimotor cortex. Moreover, baseline functional connectivity between these brain areas may serve as a predictor for the extent of pain relief induced by THC.
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Affiliation(s)
- Libat Weizman
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Lior Dayan
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Silviu Brill
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Hadas Nahman-Averbuch
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Talma Hendler
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Giris Jacob
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Haggai Sharon
- From the Sagol Brain Institute (L.W., T.H., H.S.), Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine (L.D., S.B., H.S.), and Department of Internal Medicine F (G.J.), Tel-Aviv Sourasky Medical Center; Sagol School of Neuroscience (L.W., T.H.) and Sackler School of Medicine (L.D., T.H., G.J., H.S.), Tel Aviv University, Israel; Department of Anesthesia (H.N.-A.), Cincinnati Children's Hospital Medical Center, OH; and Pain Management & Neuromodulation Centre (H.S.), Guy's & St Thomas' NHS Foundation Trust, London, UK.
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35
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Hughes SW, Ali M, Sharma P, Insan N, Strutton PH. Frequency-dependent top-down modulation of temporal summation by anodal transcranial direct-current stimulation of the primary motor cortex in healthy adults. Eur J Pain 2018; 22:1494-1501. [PMID: 29704875 DOI: 10.1002/ejp.1238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2018] [Indexed: 02/28/2024]
Abstract
BACKGROUND Transcranial direct-current stimulation (tDCS) applied over the primary motor cortex has been shown to be effective in the treatment of a number of chronic pain conditions. However, there is a lack of understanding of the top-down analgesic mechanisms involved. METHOD In this study, we investigated the effects of tDCS on the facilitation of subjective sensory and pain scores using a transcutaneous electrically evoked measure of temporal summation. In this randomized, blinded, cross-over study healthy subjects received a single stimulus given at 0.9× pain threshold (pTh) over the L5 dermatome on the lateral aspect of the right leg, followed by a train of 5 stimuli given at 0.5, 1, 5 and 20 Hz before and after 20 min of sham or anodal tDCS (2 mA) applied over the primary motor cortex. Ratings of sensation and pain intensity were scored on a visual analogue scale (VAS). RESULTS Temporal summation leading to pain only occurred at higher frequencies (5 and 20 Hz). Sham or real tDCS had no effect over temporal summation evoked at 5 Hz; however, there was a significant analgesic effect at 20 Hz. Sham or real tDCS had no effect over acute, single stimuli-evoked responses. CONCLUSION These results indicate that anodal tDCS applied to the primary motor cortex preferentially modulates temporal summation induced by high-frequency electrical stimulation-induced pain. The inhibitory effects of tDCS appear to be dynamic and dependent on the degree of spinal cord excitability and may explain the higher analgesic efficacy in patients with moderate to severe chronic pain symptoms. SIGNIFICANCE The analgesic effects of tDCS are dependent on spinal cord excitability. This work provides insight into top-down modulation during acute pain and temporal summation. This knowledge may explain why tDCS has a higher analgesic efficacy in chronic pain patients.
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Affiliation(s)
- S W Hughes
- Faculty of Medicine, The Nick Davey Laboratory, Imperial College London, London, UK
| | - M Ali
- Faculty of Medicine, The Nick Davey Laboratory, Imperial College London, London, UK
| | - P Sharma
- Faculty of Medicine, The Nick Davey Laboratory, Imperial College London, London, UK
| | - N Insan
- Faculty of Medicine, The Nick Davey Laboratory, Imperial College London, London, UK
| | - P H Strutton
- Faculty of Medicine, The Nick Davey Laboratory, Imperial College London, London, UK
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36
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Thibaut A, Zafonte R, Morse LR, Fregni F. Understanding Negative Results in tDCS Research: The Importance of Neural Targeting and Cortical Engagement. Front Neurosci 2017; 11:707. [PMID: 29311787 PMCID: PMC5732989 DOI: 10.3389/fnins.2017.00707] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/01/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Aurore Thibaut
- Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Harvard University, Boston, MA, United States.,Coma Science Group, GIGA-Consciousness, University Hospital of Liege, University of Liege, Liege, Belgium
| | - Ross Zafonte
- Spaulding-Harvard SCI Model System Center, Spaulding Rehabilitation Hospital, Boston, MA, United States.,Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA, United States.,Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Leslie R Morse
- Spaulding-Harvard SCI Model System Center, Spaulding Rehabilitation Hospital, Boston, MA, United States.,Rocky Mountain Regional Spinal Injury System, Craig Rehabilitation Hospital, Englewood, CO, United States.,Department of PMR, University of Colorado School of Medicine, University of Colorado, Aurora, CO, United States
| | - Felipe Fregni
- Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Harvard University, Boston, MA, United States.,Spaulding-Harvard SCI Model System Center, Spaulding Rehabilitation Hospital, Boston, MA, United States
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37
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Transcranial direct current stimulation over the primary motor vs prefrontal cortex in refractory chronic migraine: A pilot randomized controlled trial. J Neurol Sci 2017; 378:225-232. [PMID: 28566169 DOI: 10.1016/j.jns.2017.05.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/04/2017] [Accepted: 05/02/2017] [Indexed: 12/21/2022]
Abstract
Although transcranial direct current stimulation (tDCS) represents a therapeutic option for the prophylaxis of chronic migraine, the target area for application of the electrical current to the cortex has not yet been well established. Here we sought to determine whether a treatment protocol involving 12 sessions of 2mA, 20min anodal stimulation of the left primary motor (M1) or dorsolateral prefrontal cortex (DLPFC) could offer clinical benefits in the management of pain from migraine. Thirteen participants were assessed before and after treatment, using the Headache Impact Test-6, Visual Analogue Scale and Medical Outcomes Study 36 - Item Short - Form Health Survey. After treatment, group DLPFC exhibited a better performance compared with groups M1 and sham. On intragroup comparison, groups DLPFC and M1 exhibited a greater reduction in headache impact and pain intensity and a higher quality of life after treatment. No significant change was found in group sham. The participants in group M1 exhibited more adverse effects, especially headache, heartburn, and sleepiness, than did those in the other two groups. Transcranial direct current stimulation is a safe and efficacious technique for treating chronic migraine. However, it should be kept in mind that the site of cortical stimulation might modulate the patient's response to treatment.
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