High-definition transcranial direct current stimulation induces both acute and persistent changes in broadband cortical synchronization: a simultaneous tDCS-EEG study

An Investigation of Parameter-Dependent Cell-Type Specific Effects of Transcranial Focused Ultrasound Stimulation Using an Awake Head-Fixed Rodent Model

Transcranial focused ultrasound (tFUS) is a promising neuromodulation technique able to target shallow and deep brain structures with high precision. Previous studies have demonstrated that tFUS stimulation responses are both cell-type specific and controllable through altering stimulation parameters. Specifically, tFUS can elicit time-locked neural activity in regular spiking units (RSUs) that is sensitive to increases in pulse repetition frequency (PRF), while time-locked responses are not seen in fast spiking units (FSUs). These findings suggest a unique capability of tFUS to alter circuit network dynamics with cell-type specificity; however, these results could be biased by the use of anesthesia, which significantly modulates neural activities. In this study, we develop an awake head-fixed rat model specifically designed for tFUS study, and address a key question if tFUS still has cell-type specificity under awake conditions. Using this novel animal model, we examined a series of PRFs and burst duty cycles (DCs) to determine their effects on neuronal subpopulations without anesthesia. We conclude that cell-type specific time-locked and delayed responses to tFUS as well as PRF and DC sensitivity are present in the awake animal model and that despite some differences in response, isoflurane anesthesia is not a major confound in studying the cell-type specificity of ultrasound neuromodulation. We further determine that, in an awake, head-fixed setting, the preferred PRF and DC for inducing time-locked excitation with our pulsed tFUS paradigm are 1500 Hz and 60%, respectively.

Transcranial direct current stimulation alters cerebrospinal fluid-interstitial fluid exchange in mouse brain

BACKGROUND

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has gained prominence recently. Clinical studies have explored tDCS as an adjunct to neurologic disease rehabilitation, with evidence suggesting its potential in modulating brain clearance mechanisms. The glymphatic system, a proposed brain waste clearance system, posits that cerebrospinal fluid-interstitial fluid (CSF-ISF) exchange aids in efficient metabolic waste removal. While some studies have linked tDCS to astrocytic inositol trisphosphate (IP3)/Ca2+ signaling, the impact of tDCS on CSF-ISF exchange dynamics remains unclear.

HYPOTHESIS

tDCS influences the dynamics of CSF-ISF exchange through astrocytic IP3/Ca2+ signaling.

METHODS

In this study, we administered tDCS (0.1 mA for 10 min) to C57BL/6N mice anesthetized with ketamine-xylazine (KX). The anode was positioned on the cranial bone above the cortex, and the cathode was inserted into the neck. Following tDCS, we directly assessed brain fluid dynamics by injecting biotinylated dextran amine (BDA) as a CSF tracer into the cisterna magna (CM). The brain was then extracted after either 30 or 60 min and fixed. After 24 h, the sectioned brain slices were stained with Alexa 594-conjugated streptavidin (SA) to visualize BDA using immunohistochemistry. We conducted Electroencephalography (EEG) recordings and aquaporin 4 (AQP4)/CD31 immunostaining to investigate the underlying mechanisms of tDCS. Additionally, we monitored the efflux of Evans blue, injected into the cisterna magna, using cervical lymph node imaging. Some experiments were subsequently repeated with inositol trisphosphate receptor type 2 (IP3R2) knockout (KO) mice.

RESULTS

Post-tDCS, we observed an increased CSF tracer influx, indicating a modulation of CSF-ISF exchange by tDCS. Additionally, tDCS appeared to enhance the brain's metabolic waste efflux. EEG recordings showed an increase in delta wave post-tDCS. But no significant change in AQP4 expression was detected 30 min post-tDCS. Besides, we found no alteration in CSF-ISF exchange and delta wave activity in IP3R2 KO mice after tDCS.

CONCLUSION

Our findings suggest that tDCS augments the glymphatic system's influx and efflux. Through astrocytic IP3/Ca2+ signaling, tDCS was found to modify the delta wave, which correlates positively with brain clearance. This study underscores the potential of tDCS in modulating brain metabolic waste clearance.

High-definition transcranial direct current stimulation desynchronizes refractory status epilepticus

Recently, we showed that high-definition transcranial direct current stimulation (hd-tDCS) can acutely reduce epileptic spike rates during and after stimulation in refractory status epilepticus (RSE), with a greater likelihood of patient discharge from the intensive care unit compared to historical controls. We investigate whether electroencephalographic (EEG) desynchronization during hd-tDCS can help account for observed anti-epileptic effects. Defining desynchronization as greater power in higher frequencies such as above 30 ​Hz ("gamma") and lesser power in frequency bands lower than 30 ​Hz, we analyzed 27 EEG sessions from 10 RSE patients who had received 20-minute session(s) of 2-milliamperes of transcranial direct current custom-targeted at the epileptic focus as previously determined by a clinical EEGer monitoring the EEG in real-time. During hd-tDCS, median relative power change over the EEG electrode chains in which power changes were maximal was +4.84%, -5.25%, -1.88%, -1.94%, and +4.99% for respective delta, theta, alpha, beta, and gamma frequency bands in the bipolar longitudinal montage (p ​= ​0.0001); and +4.13%, -5.44%, -1.81%, -3.23%, and +5.41% in the referential Laplacian montage (p ​= ​0.0012). After hd-tDCS, median relative power changes reversed over the EEG electrode chains in which power changes were maximal: -2.74%, +4.20%, +1.74%, +1.75%, and -4.68% for the respective delta, theta, alpha, beta, and gamma frequency bands in the bipolar longitudinal montage (p ​= ​0.0001); and +1.59%, +5.07%, +1.74%, +2.40%, and -5.12% in the referential Laplacian montage (p ​= ​0.0004). These findings are consistent with EEG desynchronization through theta-alpha-beta-gamma bands during hd-tDCS, helping account for the efficacy of hd-tDCS as an emerging novel anti-epileptic therapy against RSE.

Feasibility of undersampled spiral trajectories in MREPT for fast conductivity imaging

PURPOSE

To investigate spiral-based imaging including trajectories with undersampling as a fast and robust alternative for phase-based magnetic resonance electrical properties tomography (MREPT) techniques.

METHODS

Spiral trajectories with various undersampling ratios were prescribed to acquire images from an experimental phantom and a healthy volunteer at 3T. The non-Cartesian acquisitions were reconstructed using SPIRiT, and conductivity maps were derived using phase-based cr-MREPT. The resulting maps were compared between different sampling trajectories. Additionally, a conductivity map was obtained using a Cartesian balanced SSFP acquisition from the volunteer to comparatively demonstrate the robustness of the proposed method.

RESULTS

The phantom and volunteer results illustrate the benefits of the spiral acquisitions. Specifically, undersampled spiral acquisitions display improved robustness against field inhomogeneity artifacts and lowered SD values with shortened readout times. Furthermore, average of conductivity values measured for the cerebrospinal fluid with the spiral acquisitions were 1.703 S/m, indicating a close agreement with the theoretical values of 1.794 S/m.

CONCLUSION

A spiral-based acquisition framework for conductivity imaging with and without undersampling is presented. Overall, spiral-based acquisitions improved robustness against field inhomogeneity artifacts, while achieving whole head coverage with multiple averages in less than a minute.

Event-Related EEG Desynchronization Reveals Enhanced Motor Imagery From the Third Person Perspective by Manipulating Sense of Body Ownership With Virtual Reality for Stroke Patients

Virtual reality (VR)-based rehabilitation training holds great potential for post-stroke motor recovery. Existing VR-based motor imagery (MI) paradigms mostly focus on the first-person perspective, and the benefit of the third-person perspective (3PP) remains to be further exploited. The 3PP is advantageous for movements involving the back or those with a large range because of its field coverage. Some movements are easier to imagine from the 3PP. However, the 3PP training efficiency may be unsatisfactory, which may be attributed to the difficulty encountered when generating a strong sense of ownership (SOO). In this work, we attempt to enhance a visual-guided 3PP MI in stroke patients by eliciting the SOO over a virtual avatar with VR. We propose to achieve this by inducing the so-called out-of-body experience (OBE), which is a full-body illusion (FBI) that people misperceive a 3PP virtual body as his/her own (i.e., generating the SOO to the virtual body). Electroencephalography signals of 13 stroke patients are recorded while MI of the affected upper limb is being performed. The proposed paradigm is evaluated by comparing event-related desynchronization (ERD) with a control paradigm without FBI induction. The results show that the proposed paradigm leads to a significantly larger ERD during MI, indicating a bilateral activation pattern consistent with that in previous studies. In conclusion, 3PP MI can be enhanced in stroke patients by eliciting the SOO through induction of the "OBE" FBI. This study offers more possibilities for virtual rehabilitation in stroke patients and can further facilitate VR application in rehabilitation.

Anodal HD-tDCS on the dominant anterior temporal lobe and dorsolateral prefrontal cortex: clinical results in patients with mild cognitive impairment

OBJECTIVES

Mild cognitive impairment (MCI) is a neurocognitive disorder in which the cognitive and mental abilities of humans are declined. Transcranial direct-current stimulation (tDCS) is an emerging noninvasive brain stimulation technique aimed at neuromodulation. In this study, we investigate whether high-definition anodal tDCS stimulation (anodal HD-tDCS) in MCI patients in two different brain regions will be effective in improving cognitive function.

METHODS

This study was done as a randomized, double-blind clinical trial. Sixty MCI patients (clinically diagnosed by expert neurologists) were randomly divided into three groups. Two groups received 2-mA anodal HD-tDCS for 20 min for 2 weeks (5 consecutive days in each week, 10 days in total). In the first group (twenty patients), the left dorsolateral prefrontal cortex (left DLPFC) was targeted. In the second group (twenty patients), the target zone was the dominant anterior temporal lobe (DATL). The third group (twenty patients) formed the Sham group. The Montreal Cognitive Assessment (MoCA) and Quality of Life in Alzheimer's Disease (QoLAD) were considered as the outcome measures.

RESULTS

MCI patients obtained the highest MoCA mean scores in both left DLPFC and DATL groups versus the study baseline 2 weeks after the intervention. In addition, the MoCA mean scores of MCI patients were greater in both intervention groups compared to the Sham group up to 3 months post-stimulation (p-value ≤ 0.05). However, as we moved away from the first stimulation day, a decreasing trend in the MoCA mean scores was observed. Moreover, in the left DLPFC and DATL groups, higher QoLAD mean scores were observed 3-month post-stimulation, highlighting the effectiveness of anodal HD-tDCS in improving the quality of life in MCI patients.

CONCLUSION

In this research, it was shown that applying anodal HD-tDCS at left DLPFC and DATL brain regains for two successive weeks improves cognitive function in MCI patients (by obtaining higher values of MoCA scores) up to 3 months after the intervention compared to the Sham group. This illustrates the positive effects of HD-tDCS, as a non-pharmacological intervention, for improving cognitive function and quality of life in MCI patients.

SIGNIFICANCE

Two weeks after anodal HD-tDCS of the DLPFC and DATL brain regions, the MCI patients achieved the highest MoCA mean scores compared to the Sham group across all measurement intervals.

Effect of tDCS on corticomuscular coupling and the brain functional network of stroke patients

Transcranial direct current stimulation (tDCS) is an emerging brain intervention technique that has gained growing attention in recent years in the rehabilitation area. In this paper, we investigated the efficacy of tDCS in the rehabilitation process of stroke patients, utilizing corticomuscular coupling (CMC) and brain functional network analysis. Specifically, we examined changes in CMC relationships between the treatment and control groups before and after rehabilitation by transfer entropy (TE), and constructed brain functional networks by TE. We further calculated features of the functional networks, including node degree, global efficiency, clustering coefficient, characteristic path length, and small world index. Our results demonstrate that CMC in patients increased significantly after treatment, with greater improvements in the tDCS group, particularly within the beta and gamma bands. In addition, the functional brain network analysis revealed enhanced connectivity between brain regions, improved information processing capacity, and increased transmission efficiency in patients as their condition improved. Notably, treatment with tDCS resulted in more significant improvements than the sham group, with a statistically significant difference observed after rehabilitation treatment (p < 0.05). These findings provide compelling evidence regarding the role of tDCS in the treatment of stroke and highlight the potential of this approach in stroke rehabilitation. The use of tDCS for therapeutic interventions in stroke rehabilitation can significantly improve the coupling of patients' functional brain networks. Also, using Transfer Entropy (TE) as a characteristic of CMC, tDCS was found to significantly enhance patients' TE, i.e. enhanced CMC.

Neuromodulatory feasibility of a current limiter-based tDCS device: a resting-state electroencephalography study

Recently, we introduced a current limiter-based novel transcranial direct-current stimulation (tDCS) device that does not generate significant tDCS-induced electrical artifacts, thereby facilitating simultaneous electroencephalography (EEG) measurement during tDCS application. In this study, we investigated the neuromodulatory effect of the tDCS device using resting-state EEG data measured during tDCS application in terms of EEG power spectral densities (PSD) and brain network indices (clustering coefficient and path length). Resting-state EEG data were recorded from 10 healthy subjects during both eyes-open (EO) and eyes-closed (EC) states for each of five different conditions (baseline, sham, post-sham, tDCS, and post-tDCS). In the tDCS condition, tDCS was applied for 12 min with a current intensity of 1.5 mA, whereas tDCS was applied only for the first 30 s in the sham condition. EEG PSD and brain network indices were computed for the alpha frequency band most closely associated with resting-state EEG. Both alpha PSD and network indices were found to significantly increase during and after tDCS application compared to those of the baseline condition in the EO state, but not in the EC state owing to the ceiling effect. Our results demonstrate the neuromodulatory effect of the tDCS device that does not generate significant tDCS-induced electrical artifacts, thereby allowing simultaneous measurement of electrical brain activity. We expect our novel tDCS device to be practically useful in exploring the impact of tDCS on neuromodulation more precisely using ongoing EEG data simultaneously measured during tDCS application.

Effects of active and sham tDCS on the soleus H-reflex during standing

Weak transcranial direct current stimulation (tDCS) is known to affect corticospinal excitability and enhance motor skill acquisition, whereas its effects on spinal reflexes in actively contracting muscles are yet to be established. Thus, in this study, we examined the acute effects of Active and Sham tDCS on the soleus H-reflex during standing. In fourteen adults without known neurological conditions, the soleus H-reflex was repeatedly elicited at just above M-wave threshold throughout 30 min of Active (N = 7) or Sham (N = 7) 2-mA tDCS over the primary motor cortex in standing. The maximum H-reflex (Hmax) and M-wave (Mmax) were also measured before and immediately after 30 min of tDCS. The soleus H-reflex amplitudes became significantly larger (by 6%) ≈1 min into Active or Sham tDCS and gradually returned toward the pre-tDCS values, on average, within 15 min. With Active tDCS, the amplitude reduction from the initial increase appeared to occur more swiftly than with Sham tDCS. An acute temporary increase in the soleus H-reflex amplitude within the first minute of Active and Sham tDCS found in this study indicates a previously unreported effect of tDCS on the H-reflex excitability. The present study suggests that neurophysiological characterization of Sham tDCS effects is just as important as investigating Active tDCS effects in understanding and defining acute effects of tDCS on the excitability of spinal reflex pathways.

Can vibrotactile stimulation and tDCS help inefficient BCI users?

Brain-computer interface (BCI) has helped people by allowing them to control a computer or machine through brain activity without actual body movement. Despite this advantage, BCI cannot be used widely because some people cannot achieve controllable performance. To solve this problem, researchers have proposed stimulation methods to modulate relevant brain activity to improve BCI performance. However, multiple studies have reported mixed results following stimulation, and the comparative study of different stimulation modalities has been overlooked. Accordingly, this study was designed to compare vibrotactile stimulation and transcranial direct current stimulation's (tDCS) effects on brain activity modulation and motor imagery BCI performance among inefficient BCI users. We recruited 44 subjects and divided them into sham, vibrotactile stimulation, and tDCS groups, and low performers were selected from each stimulation group. We found that the latter's BCI performance in the vibrotactile stimulation group increased significantly by 9.13% (p < 0.01), and while the tDCS group subjects' performance increased by 5.13%, it was not significant. In contrast, sham group subjects showed no increased performance. In addition to BCI performance, pre-stimulus alpha band power and the phase locking values (PLVs) averaged over sensory motor areas showed significant increases in low performers following stimulation in the vibrotactile stimulation and tDCS groups, while sham stimulation group subjects and high performers showed no significant stimulation effects across all groups. Our findings suggest that stimulation effects may differ depending upon BCI efficiency, and inefficient BCI users have greater plasticity than efficient BCI users.

Neurologic music therapy combined with EEG-tDCS for upper motor extremity performance in patients with corticobasal syndrome: Study protocol for a novel approach

BACKGROUND

Corticobasal syndrome (CBS) is an atypical parkinsonian disorder that involves degeneration of brain regions associated with motor coordination and sensory processing. Combining transcranial direct current stimulation (tDCS) with rehabilitation training has been shown to improve upper-limb performance in other disease models. Here, we describe the protocol investigating whether tDCS with neurologic music therapy (NMT) (patterned sensory enhancement and therapeutic instrumental music performance) enhances functional arm/hand performance in individuals with CBS.

METHODS

Study participants are randomly assigned to six 30-min sessions (twice per week for 3 weeks) of NMT + either sham tDCS or active tDCS. We aim to stimulate the frontoparietal cortex, which is associated with movement execution/coordination and sensory processing. The hemisphere contralateral to the more affected arm is stimulated (total stimulation current of 2 mA from 5 dime-sized electrodes). Individualized NMT sessions designed to exercise the upper limb are provided. Participants undergo gross/fine motor, cognitive and emotional assessments at baseline and follow-up (one month after the final session). To investigate the immediate effects of tDCS and NMT training, gross /fine motor, affective level, and kinematic parameter measurements using motion sensors are collected before and after each session. Electroencephalography is used to collect electrical neurophysiological responses before, during, and after tDCS+NMT sessions. The study participants, neurologic music therapist and outcome assessor are blinded to whether participants are in the sham or active tDCS group.

CONCLUSION

This noninvasive and patient-centered clinical trial for CBS may provide insight into rehabilitation options that are sorely lacking in this population.

Transcranial current stimulation in epilepsy: A systematic review of the fundamental and clinical aspects

Purpose

Transcranial electrical current stimulation (tES or tCS, as it is sometimes referred to) has been proposed as non-invasive therapy for pharmacoresistant epilepsy. This technique, which includes direct current (tDCS) and alternating current (tACS) stimulation involves the application of weak currents across the cortex to change cortical excitability. Although clinical trials have demonstrated the therapeutic efficacy of tES, its specific effects on epileptic brain activity are poorly understood. We sought to summarize the clinical and fundamental effects underlying the application of tES in epilepsy.

Methods

A systematic review was performed in accordance with the PRISMA guidelines. A database search was performed in PUBMED, MEDLINE, Web of Science and Cochrane CENTRAL for articles corresponding to the keywords “epilepsy AND (transcranial current stimulation OR transcranial electrical stimulation)”.

Results

A total of 56 studies were included in this review. Through these records, we show that tDCS and tACS epileptic patients are safe and clinically relevant techniques for epilepsy. Recent articles reported changes of functional connectivity in epileptic patients after tDCS. We argue that tDCS may act by affecting brain networks, rather than simply modifying local activity in the targeted area. To explain the mechanisms of tES, various cellular effects have been identified. Among them, reduced cell loss, mossy fiber sprouting, and hippocampal BDNF protein levels. Brain modeling and human studies highlight the influence of individual brain anatomy and physiology on the electric field distribution. Computational models may optimize the stimulation parameters and bring new therapeutic perspectives.

Conclusion

Both tDCS and tACS are promising techniques for epilepsy patients. Although the clinical effects of tDCS have been repeatedly assessed, only one clinical trial has involved a consistent number of epileptic patients and little knowledge is present about the clinical outcome of tACS. To fill this gap, multicenter studies on tES in epileptic patients are needed involving novel methods such as personalized stimulation protocols based on computational modeling. Furthermore, there is a need for more in vivo studies replicating the tES parameters applied in patients. Finally, there is a lack of clinical studies investigating changes in intracranial epileptiform discharges during tES application, which could clarify the nature of tES-related local and network dynamics in epilepsy.

Varied Response of EEG Rhythm to Different tDCS Protocols and Lesion Hemispheres in Stroke Subjects with Upper Limb Dysfunction

Transcranial direct current stimulation (tDCS) provides a way to modulate the cortical activity and promote motor rehabilitation following stroke. However, evidence indicates that the response to tDCS is highly variable. This study was aimed at exploring rhythmic response of Electroencephalography (EEG) to three tDCS protocols in stroke subjects. We hypothesize that tDCS protocols may interact with stoke characteristics, and electrode placement may affect cortical activity which could be reflected by the EEG rhythm. 32 subjects with unilateral stroke were recruited to a single-blinded, randomized, and controlled crossover experiment. All of the subjects underwent four tDCS protocols (anodal (atDCS), cathodal (ctDCS), and bilateral tDCS (bi-tDCS) and sham) with an interval of at least 1 week. Resting-state EEG was acquired before and after the stimulation. We tested the change of EEG spectral power after tDCS and the difference of change among four protocols using the paired-sample t-test and repeated measures analysis of variance. Then, we investigated the clinical factors affecting the above changes using the linear and quadratic regression model. According to the results, EEG responded to atDCS and bi-tDCS protocols on alpha and beta rhythm and subjects with a left lesion had higher response than those with the right lesion. Besides that, the change of alpha and beta power after atDCS and of beta power after bi-tDCS showed association with clinical characteristics only in subjects with the left lesion. In conclusion, the study found varied EEG response with different protocols, lesion hemispheres, and other clinical characteristics supporting the individualized cortical oscillatory effect induced by tDCS.

Alpha rhythm of electroencephalography was modulated differently by three transcranial direct current stimulation protocols in patients with ischemic stroke

The heterogeneity of transcranial direct current stimulation (tDCS) protocols and clinical profiles may explain variable results in modulating excitability in the motor cortex after stroke. However, the cortical electrical effects induced by different tDCS protocols remain unclear. Here, we aimed to compare rhythm changes in electroencephalography (EEG) induced by three tDCS position protocols and the association between tDCS effects and clinical factors in stroke. Nineteen patients with chronic ischemic stroke underwent four experimental sessions with three tDCS protocols [anodal (atDCS), cathodal (ctDCS), and bilateral (bi-tDCS)] and a sham protocol, according to a single-blind randomized crossover design. Resting-state EEG was acquired before and after each protocol. First, a paired-sample t-test was used to examine the difference in spectral power between pre- and post-stimulation. Then, linear and quadratic regression models were used separately to describe the association between the clinical factors of stroke and changes in spectral power which was significantly different between pre- and post-tDCS. Finally, repeated measures analysis of variance with lesion hemisphere, stimulation protocol, and the location was performed to investigate the effects of tDCS over time. The induced effect of tDCS was mainly reflected in the alpha rhythms. The alpha power was increased by atDCS, especially low-alpha (8–10 Hz), in localized areas of the central and distant areas of the frontal and parietal lobes. Bi-tDCS also affected alpha power but in a smaller area that mainly focused on high-alpha rhythms (10–13 Hz). However, ctDCS and sham had no significant effects on any EEG rhythm. The clinical factors of time since stroke and motor impairment level were related to the change in high-alpha induced by atDCS and bi-tDCS following quadratic regression models. The above-mentioned modulation effect lasted for 20 min without attenuation. In conclusion, our findings provide evidence that the alpha rhythm of EEG is modulated differently by different tDCS protocols and that high alpha is affected by clinical characteristics such as post-stroke time and motor deficits, which is of great significance for understanding the modulation effect of different tDCS protocols on stroke and the guidance of protocols to promote motor recovery following stroke.

tDCS-EEG for Predicting Outcome in Patients With Unresponsive Wakefulness Syndrome

Objectives

We aimed to assess the role of transcranial direct current stimulation (tDCS) combined with electroencephalogram (EEG) for predicting prognosis in UWS cases.

Methods

This was a historical control study that enrolled 85 patients with UWS. The subjects were assigned to the control (without tDCS) and tDCS groups. Conventional treatments were implemented in both the control and tDCS groups, along with 40 multi-target tDCS sessions only in the tDCS group. Coma Recovery Scale-Revised (CRS-R) was applied at admission. The non-linear EEG index was evaluated after treatment. The modified Glasgow Outcome Scale (mGOS) was applied 12 months after disease onset.

Results

The mGOS improvement rate in the tDCS group (37.1%) was higher than the control value (22.0%). Linear regression analysis revealed that the local and remote cortical networks under unaffected pain stimulation conditions and the remote cortical network under affected pain stimulation conditions were the main relevant factors for mGOS improvement. Furthermore, the difference in prefrontal-parietal cortical network was used to examine the sensitivity of prognostic assessment in UWS patients. The results showed that prognostic sensitivity could be increased from 54.5% (control group) to 84.6% (tDCS group).

Conclusions

This study proposes a tDCS-EEG protocol for predicting the prognosis of UWS. With multi-target tDCS combined with EEG, the sensitivity of prognostic assessment in patients with UWS was improved. The recovery might be related to improved prefrontal-parietal cortical networks of the unaffected hemisphere.

Study Protocol of tDCS Based Pain Modulation in Head and Neck Cancer Patients Under Chemoradiation Therapy Condition: An fNIRS-EEG Study

Background

Multiple therapeutic strategies have been adopted to reduce pain, odynophagia, and oral mucositis in head and neck cancer patients. Among them, transcranial direct current stimulation (tDCS) represents a unique analgesic modality. However, the details of tDCS mechanisms in pain treatment are still unclear.

Aims

(1) to study the analgesic effects of a protocol that encompassed supervised-remote and in-clinic tDCS sessions applied in head and neck patients undergoing chemoradiation therapy; (2) to explore the underlining brain mechanisms of such modulation process, using a novel protocol that combined functional near-infrared spectroscopy (fNIRS), and electroencephalograph (EEG), two distinct neuroimaging methods that bring information regarding changes in the hemodynamic as well as in the electrical activity of the brain, respectively.

Methods

This proof-of-concept study was performed on two subjects. The study protocol included a 7-week-long tDCS stimulation procedure, a pre-tDCS baseline session, and two post-tDCS follow-up sessions. Two types of tDCS devices were used. One was used in the clinical setting and the other remotely. Brain imaging was obtained in weeks 1, 2, 5, 7, 8, and after 1 month.

Results

The protocol implemented was safe and reliable. Preliminary results of the fNIRS analysis in weeks 2 and 7 showed a decrease in functional connections between the bilateral prefrontal cortex (PFC) and the primary sensory cortex (S1) (p &lt; 0.05, FDR corrected). Changes in EEG power spectra were found in the PFC when comparing the seventh with the first week of tDCS.

Conclusion

The protocol combining remote and in-clinic administered tDCS and integrated fNIRS and EEG to evaluate the brain activity is feasible. The preliminary results suggest that the mechanisms of tDCS in reducing the pain of head and neck cancer patients may be related to its effects on the connections between the S1 and the PFC.

When brain stimulation backfires: the effects of prefrontal cortex stimulation on impulsivity

Transcranial direct current stimulation (tDCS) can sometimes cause the opposite of its intended effect. These reverse effects may be related in part to individual differences in personality and neurochemistry. Previous studies have demonstrated that dopamine levels can impact the effects of tDCS. In the present study, 124 healthy participants took the UPPS impulsive behavior scale. Participants then underwent a single, randomized anodal or sham tDCS session on the prefrontal cortex. While the effects of tDCS were still active, they performed the Stop Signal Task, a measure of state impulsivity. tDCS was associated with increased errors on this task in people who had higher scores on the UPPS in two facets of impulsivity that correlate with dopamine levels. tDCS had no effects on people who are low in trait impulsivity. These results suggest that the reverse effects of tDCS could be associated with inter-individual differences in personality and neurochemistry.

Transcranial Electrical Stimulation for Psychiatric Disorders in Adults: A Primer

Transcranial electrical stimulation (tES) comprises noninvasive neuromodulation techniques that deliver low-amplitude electrical currents to targeted brain regions with the goal of modifying neural activities. Expanding evidence from the past decade, specifically using transcranial direct current simulation and transcranial alternating current stimulation, presents promising applications of tES as a treatment for psychiatric disorders. In this review, the authors discuss the basic technical aspects and mechanisms of action of tES in the context of clinical research and practice and review available evidence for its clinical use, efficacy, and safety. They also review recent advancements in use of tES for the treatment of depressive disorders, schizophrenia, substance use disorders, and obsessive-compulsive disorder. Findings largely support growing evidence for the safety and efficacy of tES in the treatment of patients with resistance to existing treatment options, particularly demonstrating promising treatment outcomes for depressive disorders. Future directions of tES research for optimal application in clinical settings are discussed, including the growing home-based, patient-friendly methods and the potential pairing with existing pharmacological or psychotherapeutic treatments for enhanced outcomes. Finally, neuroimaging advancements may provide more specific mapping of brain networks, aiming at more precise tES therapeutic targeting in the treatment of psychiatric disorders.

tACS facilitates flickering driving by boosting steady-state visual evoked potentials

Objective.There has become of increasing interest in transcranial alternating current stimulation (tACS) since its inception nearly a decade ago. tACS in modulating brain state is an active area of research and has been demonstrated effective in various neuropsychological and clinical domains. In the visual domain, much effort has been dedicated to brain rhythms and rhythmic stimulation, i.e. tACS. However, less is known about the interplay between the rhythmic stimulation and visual stimulation.Approach.Here, we used steady-state visual evoked potential (SSVEP), induced by flickering driving as a widely used technique for frequency-tagging, to investigate the aftereffect of tACS in healthy human subjects. Seven blocks of 64-channel electroencephalogram were recorded before and after the administration of 20min 10Hz tACS, while subjects performed several blocks of SSVEP tasks. We characterized the physiological properties of tACS aftereffect by comparing and validating the temporal, spatial, spatiotemporal and signal-to-noise ratio (SNR) patterns between and within blocks in real tACS and sham tACS.Main results.Our result revealed that tACS boosted the 10Hz SSVEP significantly. Besides, the aftereffect on SSVEP was mitigated with time and lasted up to 5 min.Significance.Our results demonstrate the feasibility of facilitating the flickering driving by external rhythmic stimulation and open a new possibility to alter the brain state in a direction by noninvasive transcranial brain stimulation.

SNR and total acquisition time analysis of multi-echo FLASH pulse sequence for current density imaging

Magnetic Resonance Current Density Imaging (MRCDI) is an imaging modality providing cross-sectional current density (J¯) information inside the body. The clinical applicability of MRCDI is highly dependent on the sensitivity of the acquired noisy current-induced magnetic flux density (B∼_z) distributions. Here, a novel analysis is developed to investigate the combined effect of relevant parameters of the RF spoiled gradient echo (FLASH) pulse sequence on the SNR level and the total acquisition time (TAT) of the acquired B∼_z images. The proposed analysis then is expanded for a multi-echo FLASH (ME-FLASH) pulse sequence to take advantage of combining the multiple echoes to achieve B∼_z^comb distribution with a higher SNR than the one achievable with a single echo acquisition. The optimized sequence parameters to acquire a B∼_z distribution with the highest possible SNR for a given acquisition time or the desired SNR in the shortest scan time are estimated using the proposed analysis. The analysis also provides different sets of sequence parameters to acquire B∼_z distributions with the same SNR at almost the same TAT. Furthermore, the effects of intensive utilization of the gradients and the magnetohydrodynamic (MHD) flow velocity on the acquired B∼_z distribution in MRCDI experiments is investigated. The analytical results of the proposed analysis are validated experimentally using an imaging phantom having the conductivity and the relaxation parameters of the brain white matter tissue.

Investigation of displacement of intracranial electrode induced by focused ultrasound stimulation

Transcranial focused ultrasound (tFUS) is an emerging neuromodulation technique to modulate brain activity non-invasively with high spatial specificity and focality. Given the influence of tFUS on brain activity, combining tFUS with multi-channel intracranial electrophysiological recordings enables monitoring of the activity of large populations of neurons with high temporal resolution. However, the physical interactions between tFUS and the electrode may affect a reliable assessment of neuronal activity, which remains poorly understood. In this paper, high-frequency ultrasound (HFUS) system was developed and integrated into tFUS neuromodulation system. The performance of the HFUS-based displacement tracking and analysis was evaluated by the theoretical analysis in the literature. The effects of various pressure levels on the displacements of the silicon-based microelectrode array in ex vivo brain tissue were investigated. The developed approach was capable of tracking and measuring the motion of a solid sphere in a tissue-mimicking phantom and measured displacements were comparable to theoretical predictions. The significant changes in the averaged peak displacements of the microelectrode array in ex vivo brain were observed with a pulse duration of 200 μs and a peak-to-peak pressure from 131 kPa at a center frequency of 500 kHz compared with the values from the negative control group. The present results demonstrate the relationship between several pressure levels and displacements of the microelectrode array in ex vivo brain through the developed approach. This approach can be used to determine a vibration-free threshold of ultrasound parameters in multi-channel intracranial recordings for a reliable assessment of electrophysiological activities of living neurons.

Dataset of concurrent EEG, ECG, and behavior with multiple doses of transcranial electrical stimulation

We present a dataset combining human-participant high-density electroencephalography (EEG) with physiological and continuous behavioral metrics during transcranial electrical stimulation (tES). Data include within participant application of nine High-Definition tES (HD-tES) types, targeting three cortical regions (frontal, motor, parietal) with three stimulation waveforms (DC, 5 Hz, 30 Hz); more than 783 total stimulation trials over 62 sessions with EEG, physiological (ECG, EOG), and continuous behavioral vigilance/alertness metrics. Experiment 1 and 2 consisted of participants performing a continuous vigilance/alertness task over three 70-minute and two 70.5-minute sessions, respectively. Demographic data were collected, as well as self-reported wellness questionnaires before and after each session. Participants received all 9 stimulation types in Experiment 1, with each session including three stimulation types, with 4 trials per type. Participants received two stimulation types in Experiment 2, with 20 trials of a given stimulation type per session. Within-participant reliability was tested by repeating select sessions. This unique dataset supports a range of hypothesis testing including interactions of tDCS/tACS location and frequency, brain-state, physiology, fatigue, and cognitive performance.

Delta oscillation underlies the interictal spike changes after repeated transcranial direct current stimulation in a rat model of chronic seizures

BACKGROUND

Transcranial direct current stimulation (tDCS) provides a noninvasive polarity-specific constant current to treat epilepsy, through a mechanism possibly involving excitability modulation and neural oscillation.

OBJECTIVE

To determine whether EEG oscillations underlie the interictal spike changes after tDCS in rats with chronic spontaneous seizures.

METHODS

Rats with kainic acid-induced spontaneous seizures were subjected to cathodal tDCS or sham stimulation for 5 consecutive days. Video-EEG recordings were collected immediately pre- and post-stimulation and for the subsequent 2 weeks following stimulation. The acute pre-post stimulation and subacute follow-up changes of interictal spikes and EEG oscillations in tDCS-treated rats were compared with sham. Ictal EEG with seizure behaviors, hippocampal brain-derived neurotrophic factor (BDNF) protein expression, and mossy fiber sprouting were compared between tDCS and sham rats.

RESULTS

Interictal spike counts were reduced immediately following tDCS with augmented delta and diminished beta and gamma oscillations compared with sham. Cathodal tDCS also enhanced delta oscillations in normal rats. However, increased numbers of interictal spikes with a decrease of delta and theta oscillations were observed in tDCS-treated rats compared with sham during the following 2 weeks after stimulation. Resuming tDCS suppressed the increase of interictal spike activity. In tDCS rats, hippocampal BDNF protein expression was decreased while mossy fiber sprouting did not change compared with sham.

CONCLUSIONS

The inverse relationship between the changes of delta oscillation and interictal spikes during tDCS on and off stimulation periods indicates that an enhanced endogenous delta oscillation underlies the tDCS inhibitory effect on epileptic excitability.

Effects of transcranial static magnetic stimulation over the primary motor cortex on local and network spontaneous electroencephalogram oscillations

Transcranial static magnetic stimulation (tSMS) is a novel non-invasive brain stimulation technique that reduces cortical excitability at the stimulation site. We investigated the effects of tSMS over the left primary motor cortex (M1) for 20 min on the local electroencephalogram (EEG) power spectrum and interregional EEG coupling. Twelve right-handed healthy subjects participated in this crossover, double-blind, sham-controlled study. Resting-state EEG data were recorded for 3 min before the intervention and 17 min after the beginning of the intervention. The power spectrum at the left central electrode (C3) and the weighted phase lag index (wPLI) between C3 and the other electrodes was calculated for theta (4-8 Hz), alpha (8-12 Hz), and beta (12-30 Hz) frequencies. The tSMS significantly increased theta power at C3 and the functional coupling in the theta band between C3 and the parietal midline electrodes. The tSMS over the left M1 for 20 min exhibited modulatory effects on local cortical activity and interregional functional coupling in the theta band. The neural oscillations in the theta band may have an important role in the neurophysiological effects induced by tSMS over the frontal cortex.

Effect of radiofrequency inhomogeneity on water-content based electrical properties tomography and its correction by flip angle maps

Water-content based electrical properties tomography (wEPT) can retrieve electrical properties (EPs) from water-content maps. B₁⁺ field information is not involved in the traditional magnetic resonance electrical properties tomography approach. wEPT can be performed through conventional MR scanning, such as T₁-weighted spin-echo imaging, which provides convenient access to multiple clinical applications. However, the inhomogeneous radiofrequency (RF) field induced by RF coils would cause inaccuracy in wEPT reconstructions during MR scanning. We conducted a detailed investigation to evaluate the effect of inhomogeneous RF field on wEPT reconstructions to guarantee that EP mapping is desired for clinical practice. Two important considerations are involved, namely, multiple typical coil configurations and various flip angles (FAs). We proposed a correction scheme with actual FA mapping to calibrate the RF inhomogeneity and finally validated it by using human imaging at 3 T. This study illustrates a detailed evaluation for wEPT under imperfect RF homogeneity and further provides a feasible correction procedure to mitigate it. The profound knowledge of wEPT provided in our work will benefit its performance in clinical applications.

Non-invasive brain stimulation for Parkinson's disease: Clinical evidence, latest concepts and future goals: A systematic review

Parkinson's disease (PD) is becoming a major public-health issue in an aging population. Available approaches to treat advanced PD still have limitations; new therapies are needed. The non-invasive brain stimulation (NIBS) may offer a complementary approach to treat advanced PD by personalized stimulation. Although NIBS is not as effective as the gold-standard levodopa, recent randomized controlled trials show promising outcomes in the treatment of PD symptoms. Nevertheless, only a few NIBS-stimulation paradigms have shown to improve PD's symptoms. Current clinical recommendations based on the level of evidence are reported in Table 1 through Table 3. Furthermore, novel technological advances hold promise and may soon enable the non-invasive stimulation of deeper brain structures for longer periods.

Neuromodulation Management of Chronic Neuropathic Pain in The Central Nervous system

Neuromodulation is becoming one of the clinical tools for treating chronic neuropathic pain by transmitting controlled physical energy to the pre-identified neural targets in the central nervous system. Its nature of drug-free, non-addictive and improved targeting have attracted increasing attention among neuroscience research and clinical practices. This article provides a brief overview of the neuropathic pain and pharmacological routines for treatment, summarizes both the invasive and non-invasive neuromodulation modalities for pain management, and highlights an emerging brain stimulation technology, transcranial focused ultrasound (tFUS) with a focus on ultrasound transducer devices and the achieved neuromodulation effects and applications on pain management. Practical considerations of spatial guidance for tFUS are discussed for clinical applications. The safety of transcranial ultrasound neuromodulation and its future prospectives on pain management are also discussed.

Network-level mechanisms underlying effects of transcranial direct current stimulation (tDCS) on visuomotor learning

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation approach in which low level currents are administered over the scalp to influence underlying brain function. Prevailing theories of tDCS focus on modulation of excitation-inhibition balance at the local stimulation location. However, network level effects are reported as well, and appear to depend upon differential underlying mechanisms. Here, we evaluated potential network-level effects of tDCS during the Serial Reaction Time Task (SRTT) using convergent EEG- and fMRI-based connectivity approaches. Motor learning manifested as a significant (p <.0001) shift from slow to fast responses and corresponded to a significant increase in beta-coherence (p <.0001) and fMRI connectivity (p <.01) particularly within the visual-motor pathway. Differential patterns of tDCS effect were observed within different parametric task versions, consistent with network models. Overall, these findings demonstrate objective physiological effects of tDCS at the network level that result in effective behavioral modulation when tDCS parameters are matched to network-level requirements of the underlying task.

Development of a transcranial direct current stimulation device based on current limiter for simultaneous measurement of electroencephalography: A feasibility study

BACKGROUND:

Electroencephalography (EEG) measured during transcranial direct current stimulation (tDCS) can help understand the accurate impact of tDCS on the brain, but this has been hindered due to significant inflow of tDCS-induced electrical artifacts.

OBJECTIVE:

In this study, we introduce a novel tDCS device developed based on current limiter, which can prevent the generation of significant electrical artifacts.

METHODS:

To verify the feasibility of our developed tDCS device, we performed simultaneous measurement of EEG during tDCS application with five different current intensities (0, 500, 1,000, 1,500, and 2,000 μA). Changes in EEG power spectral density (PSD) and correlation between the PSD of non-stimulation and tDCS condition were investigated to see whether our tDCS device can be used for simultaneous EEG recording without significant inflow of tDCS-induced electrical artifacts.

RESUTLS:

The mean EEG-PSD differences between non-stimulation and tDCS condition were not significant for all stimulation current intensities. Furthermore, EEG-PSDs estimated during non-stimulation and tDCS application showed statistically high correlation for all comparison cases.

CONCLUSION:

Based on the results, we could demonstrate the feasibility of our tDCS device based on current limiter for simultaneous EEG measurement, which could potentially provide a way to investigate the impact of tDCS on the brain more accurately.

A robust electrical conductivity imaging method with total variation and wavelet regularization

PURPOSE

This study aims to develop and evaluate a robust conductivity imaging method that combines total variation and wavelet regularization to enhance the accuracy of conductivity maps.

THEORY AND METHODS

The proposed approach is based on a gradient-based method. The central equation is derived from Maxwell's equation and describes the relationship between conductivity and the transceive phase. A linear system equation is obtained via a finite-difference method and solved using a least-squares method. Total variation and wavelet transform regularization terms are added to the minimization problem and solved using the Split Bregman method to improve reconstruction stability. The proposed approach is compared with conventional and gradient-based methods. Numerical simulations are performed to validate the accuracy of the developed method, and the effects of noise are determined. Phantom and in vivo experiments are conducted at 3 T to verify the clinical applicability of the proposed method.

RESULTS

Numerical simulations show that the proposed method is more robust than other methods and can suppress the effects of noise. The quantitative conductivity value of the phantom experiment agrees with the measured value. The in vivo experiment results present a clear structure, and the conductivity value of the tumor region is significantly higher than that around healthy tissues.

CONCLUSION

The proposed electrical conductivity imaging method can improve the quality of conductivity reconstruction, and thus, has future clinical applications.

Input-Output Functions in Human Heads Obtained With Cochlear Implant and Transcranial Electric Stimulation

OBJECTIVES

Electric stimulation is used to treat a number of neurologic disorders such as epilepsy and depression. However, delivering the required current to far-field neural targets is often ineffective because of current spread through low-impedance pathways. Here, the specific aims are to develop an empirical measure for current passing through the human head and to optimize stimulation strategies for targeting deeper structures, including the auditory nerve, by utilizing the cochlear implant (CI).

MATERIALS AND METHODS

Outward input/output (I/O) functions were obtained by CI stimulation and recording scalp potentials in five CI subjects. Conversely, inward I/O functions were obtained by noninvasive transcranial electric stimulation (tES) and recording intracochlear potentials using the onboard recording capability of the CI.

RESULTS

I/O measures indicate substantial current spread, with a maximum of 2.2% gain recorded at the inner ear target during tES (mastoid-to-mastoid electrode configuration). Similarly, CI stimulation produced a maximum of 1.1% gain at the scalp electrode nearest the CI return electrode. Gain varied with electrode montage according to a point source model that accounted for distances between the stimulating and recording electrodes. Within the same electrode montages, current gain patterns varied across subjects suggesting the importance of tissue properties, geometry, and electrode positioning.

CONCLUSION

These results provide a novel objective measure of electric stimulation in the human head, which can help to optimize stimulation parameters that improve neural excitation of deep structures by reducing the influence of current spread.

Transcranial electrical stimulation nomenclature

Transcranial electrical stimulation (tES) aims to alter brain function non-invasively by applying current to electrodes on the scalp. Decades of research and technological advancement are associated with a growing diversity of tES methods and the associated nomenclature for describing these methods. Whether intended to produce a specific response so the brain can be studied or lead to a more enduring change in behavior (e.g. for treatment), the motivations for using tES have themselves influenced the evolution of nomenclature, leading to some scientific, clinical, and public confusion. This ambiguity arises from (i) the infinite parameter space available in designing tES methods of application and (ii) varied naming conventions based upon the intended effects and/or methods of application. Here, we compile a cohesive nomenclature for contemporary tES technologies that respects existing and historical norms, while incorporating insight and classifications based on state-of-the-art findings. We consolidate and clarify existing terminology conventions, but do not aim to create new nomenclature. The presented nomenclature aims to balance adopting broad definitions that encourage flexibility and innovation in research approaches, against classification specificity that minimizes ambiguity about protocols but can hinder progress. Constructive research around tES classification, such as transcranial direct current stimulation (tDCS), should allow some variations in protocol but also distinguish from approaches that bear so little resemblance that their safety and efficacy should not be compared directly. The proposed framework includes terms in contemporary use across peer-reviewed publications, including relatively new nomenclature introduced in the past decade, such as transcranial alternating current stimulation (tACS) and transcranial pulsed current stimulation (tPCS), as well as terms with long historical use such as electroconvulsive therapy (ECT). We also define commonly used terms-of-the-trade including electrode, lead, anode, and cathode, whose prior use, in varied contexts, can also be a source of confusion. This comprehensive clarification of nomenclature and associated preliminary proposals for standardized terminology can support the development of consensus on efficacy, safety, and regulatory standards.

Assessing tDCS Placebo Effects on EEG and Cognitive Tasks

Divergent thinking (DT) using transcranial direct current stimulation (tDCS) has previously been documented with promising results. This paper examines the placebo effect of tDCS. The reaction from a placebo group was tapped using electroencephalogram (EEG). Their performance was measured as a creativity score and compared to a control group. The experiments included multiplication problems and two DT tasks: Alternative Uses Tasks (AUT) and Instances Task (IT). Neither of the groups were sham stimulated during AUT, but during IT the placebo group was sham stimulated. An automatic noise-detection algorithm was developed to remove the speech-induced EEG noise. Features of power, Welchs power spectral density (WPSD) and Welchs cross PSD (WCPSD)/frequency-band/channel were extracted and fed to the Support Vector Machine (SVM) classifiers. The χ²-test showed a significant difference (p<; 0.001) between the no stimulation and sham stimulation conditions when compared to the control group, confirming a placebo effect.

Modulating Activity in the Prefrontal Cortex Changes Intertemporal Choice for Loss: A Transcranial Direct Current Stimulation Study

Intertemporal choice refers to decisions involving tradeoffs between costs and benefits occurring at different times. Studies have found that weighting the time and benefits during decision-making involves a complex neural network that includes the dorsolateral prefrontal cortex (DLPFC). However, in contrast to literature regarding intertemporal choice for gains, studies have not provided causal evidence that the DLPFC is involved in intertemporal choice for losses. We examined whether bifrontal transcranial direct current stimulation (tDCS) applied over the right and left prefrontal cortex can alter the balance of intertemporal preference in the loss condition. A total of 60 participants performed delay discounting tasks for losses while receiving either right anodal/left cathodal, left anodal/right cathodal, or sham stimulation. The results showed that participants tended to choose larger delayed losses after receiving left anodal/right cathodal tDCS. Left anodal/right cathodal tDCS significantly decreased the discounting rate compared with the sham stimulation. These findings confirm that DLPFC activity is critical during intertemporal decision-making for losses.

A Systemic Review of Functional Near-Infrared Spectroscopy for Stroke: Current Application and Future Directions

Background: Survivors of stroke often experience significant disability and impaired quality of life. The recovery of motor or cognitive function requires long periods. Neuroimaging could measure changes in the brain and monitor recovery process in order to offer timely treatment and assess the effects of therapy. A non-invasive neuroimaging technique near-infrared spectroscopy (NIRS) with its ambulatory, portable, low-cost nature without fixation of subjects has attracted extensive attention. Methods: We conducted a comprehensive literature review in order to review the use of NIRS in stroke or post-stroke patients in July 2018. NCBI Pubmed database, EMBASE database, Cochrane Library and ScienceDirect database were searched. Results: Overall, we reviewed 66 papers. NIRS has a wide range of application, including in monitoring upper limb, lower limb recovery, motor learning, cortical function recovery, cerebral hemodynamic changes, cerebral oxygenation, as well as in therapeutic method, clinical researches, and evaluation of the risk for stroke. Conclusions: This study provides a preliminary evidence of the application of NIRS in stroke patients as a monitoring, therapeutic, and research tool. Further studies could give more emphasize on the combination of NIRS with other techniques and its utility in the prevention of stroke.

Anodal tDCS modulates cortical activity and synchronization in Parkinson's disease depending on motor processing

Background

Transcranial direct current stimulation (tDCS) may alleviate motor symptoms in Parkinson's disease (PD). However, the neurophysiological effects of tDCS on cortical activation, synchronization, and the relation to clinical motor symptoms and motor integration need characterization.

Objective

We aimed to explore the effect of tDCS over the left sensorimotor area on clinical motor outcome, right hand fine motor performance as well as cortical activity and synchronization in the high beta range.

Methods

In this double-blind randomized sham-controlled clinico-neurophysiological study we investigated ten idiopathic PD patients and eleven matched healthy controls (HC) on two days during an isometric precision grip task and at rest before and after ‘verum’ and ‘sham’ anodal tDCS (20 min; 1 mA; anode [C3], cathode [Fp2]). We measured clinical outcome, fine motor performance, and analysed both cortical frequency domain activity and corticocortical imaginary coherence.

Results

tDCS improved PD motor symptoms. Neurophysiological features indicated a motor-task-specific modulation of activity and coherence from 22 to 27 Hz after ‘verum’ stimulation in PD. Activity was significantly reduced over the left sensorimotor and right frontotemporal area. Before stimulation, PD patients showed reduced coherence over the left sensorimotor area during motor task compared to HC, and this increased after ‘verum’ stimulation in the motor task. The activity and synchronization modulation were neither observed at rest, after sham stimulation nor in healthy controls.

Conclusion

Verum tDCS modulated the PD cortical network specifically during fine motor integration. Cortical oscillatory features were not in general deregulated in PD, but depended on motor processing.

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tDCS improved motor function in Parkinson's disease.

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tDCS modulated cortical beta activity and synchronization in Parkinson's disease.

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the Parkinson's disease motor network may be susceptible to cortical stimulation.

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tDCS may reverse pathologic cortical network states.

Removal of Gross Artifacts of Transcranial Alternating Current Stimulation in Simultaneous EEG Monitoring

Transcranial electrical stimulation is a widely used non-invasive brain stimulation approach. To date, EEG has been used to evaluate the effect of transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS), but most studies have been limited to exploring changes in EEG before and after stimulation due to the presence of stimulation artifacts in the EEG data. This paper presents two different algorithms for removing the gross tACS artifact from simultaneous EEG recordings. These give different trade-offs in removal performance, in the amount of data required, and in their suitability for closed loop systems. Superposition of Moving Averages and Adaptive Filtering techniques are investigated, with significant emphasis on verification. We present head phantom testing results for controlled analysis, together with on-person EEG recordings in the time domain, frequency domain, and Event Related Potential (ERP) domain. The results show that EEG during tACS can be recovered free of large scale stimulation artifacts. Previous studies have not quantified the performance of the tACS artifact removal procedures, instead focusing on the removal of second order artifacts such as respiration related oscillations. We focus on the unresolved challenge of removing the first order stimulation artifact, presented with a new multi-stage validation strategy.

Cortico-Muscular Coherence Modulated by High-Definition Transcranial Direct Current Stimulation in People With Chronic Stroke

High-definition transcranial direct current stimulation (HD-tDCS) is a potential neuromodulation apparatus for stroke rehabilitation. However, its modulatory effects in stroke subjects is still not well understood. In this paper, the offline modulatory effects of HD-tDCS on the ipsilesional primary motor cortex were investigated by performing wrist isometric contraction tasks before and after HD-tDCS in eleven unilateral chronic stroke subjects using a synchronized HD-tDCS and electroencephalogram/electromyography measurement system. This paper is a randomized, single blinded, and sham-controlled crossover study. Each subject randomly received three HD-tDCS (anode, cathode, and sham) with at least one-week washout period. Online feedback-guided medium-level wrist isometric contraction tasks were conducted for the affected upper limbs before stimulation and 10, 30, and 50 min after the end of 10-min 1-mA HD-tDCS. The characteristics of corticomuscular coherence (CMC), cortical oscillation power spectral density, and power spectral entropy were analyzed during tasks and compared across all sessions and stimulation conditions. Anode HD-tDCS induced significant CMC changes in stroke subjects, while cathode and sham stimulation did not induce significant CMC changes. The largest neuromodulation effects were observed at 10 min immediately after anodal HD-tDCS.

Modulations of dendritic Ca2+ spike with weak electric fields in layer 5 pyramidal cells

Weak electric fields (EFs) modulate input/output function of pyramidal cells. Dendritic Ca²⁺ spike is an important cellular mechanism for coupling synaptic inputs from different cortical layers, which plays a critical role in neuronal computation. This study aims to understand the effects of weak EFs on Ca²⁺ spikes initiated in the distal dendrites. We use a computational model to simulate dendritic Ca²⁺ spikes and backpropagating action potentials (APs) in layer 5 pyramidal cells. We apply uniform EFs (less than 20 mV/mm) to the model and examine how they affect the threshold for activation of Ca²⁺ spikes. We show that the effects of weak field on synaptically evoked Ca²⁺ spikes depend on the timing of synaptic inputs. When distal inputs coincide with the onset of EFs within a time window of several milliseconds, field-induced depolarization facilitates the initiation of Ca²⁺ spikes, while field-induced hyperpolarization suppresses dendritic APs. Sustained field-induced depolarization leads to the inactivation of Ca²⁺ channels and increases the threshold of Ca²⁺ spike. Sustained field-induced hyperpolarization de-inactivates Ca²⁺ channels and reduces the threshold of Ca²⁺ spike. By altering the threshold of backpropagation activated Ca²⁺ firing, field-induced depolarization increases the degree of coupling between inputs of the soma and distal dendrites, while field-induced hyperpolarization results in a decrease of coupling. The modulatory effects of weak EF are governed by the field direction with respect to the cell. Our study explains a fundamental link between field-induced polarization, dendritic Ca²⁺ spike, and somato-dendritic coupling. The findings are crucial to interpret how weak EFs achieve specific modulation of cellular activity.

Transcranial direct current stimulation (tDCS) for upper limb rehabilitation after stroke: future directions

Transcranial Direct Current Stimulation (tDCS) is a potentially useful tool to improve upper limb rehabilitation outcomes after stroke, although its effects in this regard have shown to be limited so far. Additional increases in effectiveness of tDCS in upper limb rehabilitation after stroke may for example be achieved by (1) applying a more focal stimulation approach like high definition tDCS (HD-tDCS), (2) involving functional imaging techniques during stimulation to identify target areas more exactly, (3) applying tDCS during Electroencephalography (EEG) (EEG-tDCS), (4) focusing on an effective upper limb rehabilitation strategy as an effective base treatment after stroke. Perhaps going even beyond the application of tDCS and applying alternative stimulation techniques such as transcranial Alternating Current Stimulation (tACS) or transcranial Random Noise Stimulation (tRNS) will further increase effectiveness of upper limb rehabilitation after stroke.

Inherent physiological artifacts in EEG during tDCS

Online imaging and neuromodulation is invalid if stimulation distorts measurements beyond the point of accurate measurement. In theory, combining transcranial Direct Current Stimulation (tDCS) with electroencephalography (EEG) is compelling, as both use non-invasive electrodes and image-guided dose can be informed by the reciprocity principle. To distinguish real changes in EEG from stimulation artifacts, prior studies applied conventional signal processing techniques (e.g. high-pass filtering, ICA). Here, we address the assumptions underlying the suitability of these approaches. We distinguish physiological artifacts - defined as artifacts resulting from interactions between the stimulation induced voltage and the body and so inherent regardless of tDCS or EEG hardware performance - from methodology-related artifacts - arising from non-ideal experimental conditions or non-ideal stimulation and recording equipment performance. Critically, we identify inherent physiological artifacts which are present in all online EEG-tDCS: 1) cardiac distortion and 2) ocular motor distortion. In conjunction, non-inherent physiological artifacts which can be minimized in most experimental conditions include: 1) motion and 2) myogenic distortion. Artifact dynamics were analyzed for varying stimulation parameters (montage, polarity, current) and stimulation hardware. Together with concurrent physiological monitoring (ECG, respiration, ocular, EMG, head motion), and current flow modeling, each physiological artifact was explained by biological source-specific body impedance changes, leading to incremental changes in scalp DC voltage that are significantly larger than real neural signals. Because these artifacts modulate the DC voltage and scale with applied current, they are dose specific such that their contamination cannot be accounted for by conventional experimental controls (e.g. differing stimulation montage or current as a control). Moreover, because the EEG artifacts introduced by physiologic processes during tDCS are high dimensional (as indicated by Generalized Singular Value Decomposition- GSVD), non-stationary, and overlap highly with neurogenic frequencies, these artifacts cannot be easily removed with conventional signal processing techniques. Spatial filtering techniques (GSVD) suggest that the removal of physiological artifacts would significantly degrade signal integrity. Physiological artifacts, as defined here, would emerge only during tDCS, thus processing techniques typically applied to EEG in the absence of tDCS would not be suitable for artifact removal during tDCS. All concurrent EEG-tDCS must account for physiological artifacts that are a) present regardless of equipment used, and b) broadband and confound a broad range of experiments (e.g. oscillatory activity and event related potentials). Removal of these artifacts requires the recognition of their non-stationary, physiology-specific dynamics, and individualized nature. We present a broad taxonomy of artifacts (non/stimulation related), and suggest possible approaches and challenges to denoising online EEG-tDCS stimulation artifacts.

Individual differences in learning correlate with modulation of brain activity induced by transcranial direct current stimulation

Transcranial direct current stimulation (tDCS) has been shown to enhance cognitive performance on a variety of tasks. It is hypothesized that tDCS enhances performance by affecting task related cortical excitability changes in networks underlying or connected to the site of stimulation facilitating long term potentiation. However, many recent studies have called into question the reliability and efficacy of tDCS to induce modulatory changes in brain activity. In this study, our goal is to investigate the individual differences in tDCS induced modulatory effects on brain activity related to the degree of enhancement in performance, providing insight into this lack of reliability. In accomplishing this goal, we used functional magnetic resonance imaging (fMRI) concurrently with tDCS stimulation (1 mA, 30 minutes duration) using a visual search task simulating real world conditions. The experiment consisted of three fMRI sessions: pre-training (no performance feedback), training (performance feedback which included response accuracy and target location and either real tDCS or sham stimulation given), and post-training (no performance feedback). The right posterior parietal cortex was selected as the site of anodal tDCS based on its known role in visual search and spatial attention processing. Our results identified a region in the right precentral gyrus, known to be involved with visual spatial attention and orienting, that showed tDCS induced task related changes in cortical excitability that were associated with individual differences in improved performance. This same region showed greater activity during the training session for target feedback of incorrect (target-error feedback) over correct trials for the tDCS stim over sham group indicating greater attention to target features during training feedback when trials were incorrect. These results give important insight into the nature of neural excitability induced by tDCS as it relates to variability in individual differences in improved performance shedding some light the apparent lack of reliability found in tDCS research.

Tracking the Effect of Cathodal Transcranial Direct Current Stimulation on Cortical Excitability and Connectivity by Means of TMS-EEG

Transcranial direct current stimulation (tDCS) is increasingly used in both research and therapeutic settings, but its precise mechanisms remain largely unknown. At a neuronal level, tDCS modulates cortical excitability by shifting the resting membrane potential in a polarity-dependent way: anodal stimulation increases the spontaneous firing rate, while cathodal decreases it. However, the neurophysiological underpinnings of anodal/cathodal tDCS seem to be different, as well as their behavioral effect, in particular when high order areas are involved, compared to when motor or sensory brain areas are targeted. Previously, we investigated the effect of anodal tDCS on cortical excitability, by means of a combination of Transcranial Magnetic Stimulation (TMS) and Electroencephalography (EEG). Results showed a diffuse rise of cortical excitability in a bilateral fronto-parietal network. In the present study, we tested, with the same paradigm, the effect of cathodal tDCS. Single pulse TMS was delivered over the left posterior parietal cortex (PPC), before, during, and after 10 min of cathodal or sham tDCS over the right PPC, while recording HD-EEG. Indexes of global and local cortical excitability were obtained both at sensors and cortical sources level. At sensors, global and local mean field power (GMFP and LMFP) were computed for three temporal windows (0-50, 50-100, and 100-150 ms), on all channels (GMFP), and in four different clusters of electrodes (LMFP, left and right, in frontal and parietal regions). After source reconstruction, Significant Current Density was computed at the global level, and for four Broadmann's areas (left/right BA 6 and 7). Both sensors and cortical sources results converge in showing no differences during and after cathodal tDCS compared to pre-stimulation sessions, both at global and local level. The same holds for sham tDCS. These data highlight an asymmetric impact of anodal and cathodal stimulation on cortical excitability, with a diffuse effect of anodal and no effect of cathodal tDCS over the parietal cortex. These results are consistent with the current literature: while anodal-excitatory and cathodal-inhibitory effects are well-established in the sensory and motor domains, both at physiological and behavioral levels, results for cathodal stimulation are more controversial for modulation of exitability of higher order areas.

Novel bifunctional cap for simultaneous electroencephalography and transcranial electrical stimulation

Neuromodulation induced by transcranial electric stimulation (TES) exhibited promising potential for clinical practice. However, the underlying mechanisms remain subject of research. The combination of TES and electroencephalography (EEG) offers great potential for investigating these mechanisms and brain function in general, especially when performed simultaneously. In conventional applications, the combination of EEG and TES suffers from limitations on the electrode level (gel for electrode-skin interface) and the usability level (preparation time, reproducibility of positioning). To overcome these limitations, we designed a bifunctional cap for simultaneous TES-EEG applications. We used novel electrode materials, namely textile stimulation electrodes and dry EEG electrodes integrated in a flexible textile cap. We verified the functionality of this cap by analysing the effect of TES on visual evoked potentials (VEPs). In accordance with previous reports using standard TES, the amplitude of the N75 component was significantly decreased post-stimulation, indicating the feasibility of using this novel flexible cap for simultaneous TES and EEG. Further, we found a significant reduction of the P100 component only during TES, indicating a different brain modulation effect during and after TES. In conclusion, the novel bifunctional cap offers a novel tool for simultaneous TES-EEG applications in clinical research, therapy monitoring and closed-loop stimulation.