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Drysdale AT, Poleshuck E, Ramsey MH, Monk C. New treatments: Opportunities and challenges. Semin Perinatol 2024; 48:151941. [PMID: 39068046 DOI: 10.1016/j.semperi.2024.151941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Across the spectrum of perinatal mental illness, there exist a variety of effective treatments. However, the available treatments are not always matched to the presentation, resources, constraints, or values of each patient. Furthermore, provider, local, and systemic factors complicate access to current treatment options. New and emerging approaches offer the potential of more effective treatment for specific perinatal psychiatric disorders. From neuroactive steroid medications to accelerated psychotherapy interventions, recent innovations have demonstrated enhanced efficacy on a faster timeline. Optimally, these developments will also lower barriers to care but this is not necessarily true. We review novel and upcoming interventions across perinatal mental illness and place them in the context of existing treatments and common challenges.
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Affiliation(s)
- Andrew T Drysdale
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States.
| | - Ellen Poleshuck
- Department of Psychiatry, University of Rochester Medical Center, United States; Department of Obstetrics and Gynecology, University of Rochester Medical Center, United States
| | - MaKenzie H Ramsey
- New York State Psychiatric Institute, New York, NY, United States; Department of Human Development, Teachers College, Columbia University, New York, NY, United States
| | - Catherine Monk
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States; Department of Obstetrics & Gynecology, Columbia University Medical Center, New York, NY, United States
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Daoud M, Durelle C, Fierain A, N EY, Wendling F, Ruffini G, Benquet P, Bartolomei F. Long-term Effect of Multichannel tDCS Protocol in Patients with Central Cortex Epilepsies Associated with Epilepsia Partialis Continua. Brain Topogr 2024; 37:897-906. [PMID: 38446345 DOI: 10.1007/s10548-024-01045-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
Epilepsia partialis continua (EPC) is a rare type of focal motor status epilepticus that causes continuous muscle jerking in a specific part of the body. Experiencing this type of seizure, along with other seizure types, such as focal motor seizures and focal to bilateral tonic-clonic seizures, can result in a disabling situation. Non-invasive brain stimulation methods like transcranial direct current stimulation (tDCS) show promise in reducing seizure frequency (SF) when medications are ineffective. However, research on tDCS for EPC and related seizures is limited. We evaluated personalized multichannel tDCS in drug-resistant EPC of diverse etiologies for long-term clinical efficacy We report three EPC patients undergoing a long-term protocol of multichannel tDCS. The patients received several cycles (11, 9, and 3) of five consecutive days of stimulation at 2 mA for 2 × 20 min, targeting the epileptogenic zone (EZ), including the central motor cortex with cathodal electrodes. The primary measurement was SF changes. In three cases, EPC was due to Rasmussen's Encephalitis (case 1), focal cortical dysplasia (case 2), or remained unknown (case 3). tDCS cycles were administered over 6 to 22 months. The outcomes comprised a reduction of at least 75% in seizure frequency for two patients, and in one case, a complete cessation of severe motor seizures. However, tDCS had no substantial impact on the continuous myoclonus characterizing EPC. No serious side effects were reported. Long-term application of tDCS cycles is well tolerated and can lead to a considerable reduction in disabling seizures in patients with various forms of epilepsy with EPC.
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Affiliation(s)
- M Daoud
- Aix-Marseille Univ, INSERM U1106, Institut de Neurosciences des Systèmes, Marseille, France
| | - C Durelle
- Service d'Epileptologie et de Rythmologie cérébrale, APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, 264 Rue Saint-Pierre, Marseille, 13005, France
| | - A Fierain
- Service d'Epileptologie et de Rythmologie cérébrale, APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, 264 Rue Saint-Pierre, Marseille, 13005, France
| | - El Youssef N
- Service d'Epileptologie et de Rythmologie cérébrale, APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, 264 Rue Saint-Pierre, Marseille, 13005, France
| | - F Wendling
- Univ Rennes, INSERM, LTSI-U1099, Rennes, F-35000, France
| | - G Ruffini
- Neuroelectrics Barcelona, Av. Tibidabo 47 bis, Barcelona, 08035, Spain
| | - P Benquet
- Univ Rennes, INSERM, LTSI-U1099, Rennes, F-35000, France
| | - F Bartolomei
- Aix-Marseille Univ, INSERM U1106, Institut de Neurosciences des Systèmes, Marseille, France.
- Service d'Epileptologie et de Rythmologie cérébrale, APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, 264 Rue Saint-Pierre, Marseille, 13005, France.
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Ruffini G, Salvador R, Castaldo F, Baleeiro T, Camprodon JA, Chopra M, Cappon D, Pascual-Leone A. Multichannel tDCS with advanced targeting for major depressive disorder: a tele-supervised at-home pilot study. Front Psychiatry 2024; 15:1427365. [PMID: 39211540 PMCID: PMC11358063 DOI: 10.3389/fpsyt.2024.1427365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 07/10/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Proof-of-principle human studies suggest that transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) may improve depression severity. This open-label multicenter study tested remotely supervised multichannel tDCS delivered at home in patients (N=35) with major depressive disorder (MDD). The primary aim was to assess the feasibility and safety of our protocol. As an exploratory aim, we evaluated therapeutic efficacy: the primary efficacy measure was the median percent change from baseline to the end of the 4-week post-treatment follow-up period in the observer-rated Montgomery-Asberg Depression Mood Rating Scale (MADRS). Methods Participants received 37 at-home stimulation sessions (30 minutes each) of specifically designed multichannel tDCS targeting the left DLPFC administered over eight weeks (4 weeks of daily treatments plus 4 weeks of taper), with a follow-up period of 4 weeks following the final stimulation session. The stimulation montage (electrode positions and currents) was optimized by employing computational models of the electric field generated by multichannel tDCS using available structural data from a similar population (group optimization). Conducted entirely remotely, the study employed the MADRS for assessment at baseline, at weeks 4 and 8 during treatment, and at 4-week follow-up visits. Results 34 patients (85.3% women) with a mean age of 59 years, a diagnosis of MDD according to DSM-5 criteria, and a MADRS score ≥20 at the time of study enrolment completed all study visits. At baseline, the mean time since MDD diagnosis was 24.0 (SD 19.1) months. Concerning compliance, 85% of the participants (n=29) completed the complete course of 37 stimulation sessions at home, while 97% completed at least 36 sessions. No detrimental effects were observed, including suicidal ideation and/or behavior. The study observed a median MADRS score reduction of 64.5% (48.6, 72.4) 4 weeks post-treatment (Hedge's g = -3.1). We observed a response rate (≥ 50% improvement in MADRS scores) of 72.7% (n=24) from baseline to the last visit 4 weeks post-treatment. Secondary measures reflected similar improvements. Conclusions These results suggest that remotely supervised and supported multichannel home-based tDCS is safe and feasible, and antidepressant efficacy motivates further appropriately controlled clinical studies. Clinical Trial Registration https://clinicaltrials.gov/study/NCT05205915?tab=results, identifier NCT05205915.
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Affiliation(s)
- Giulio Ruffini
- Brain Modeling Department, Neuroelectrics Barcelona, Barcelona, Spain
| | - Ricardo Salvador
- Brain Modeling Department, Neuroelectrics Barcelona, Barcelona, Spain
| | | | - Thais Baleeiro
- Brain Modeling Department, Neuroelectrics Barcelona, Barcelona, Spain
| | - Joan A. Camprodon
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Mohit Chopra
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
| | - Davide Cappon
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Alvaro Pascual-Leone
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
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Cappon D, den Boer T, Yu W, LaGanke N, Fox R, Brozgol M, Hausdorff JM, Manor B, Pascual-Leone A. An Educational Program for Remote Training and Supervision of Home-Based Transcranial Electrical Stimulation: Feasibility and Preliminary Effectiveness. Neuromodulation 2024; 27:636-644. [PMID: 37552152 PMCID: PMC10850429 DOI: 10.1016/j.neurom.2023.04.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/14/2023] [Accepted: 04/03/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES There has been recent interest in the administration of transcranial electrical stimulation (tES) by a caregiver, family member, or patient themselves while in their own homes (HB-tES). The need to properly train individuals in the administration of HB-tES is essential, and the lack of a uniform training approach across studies has come to light. The primary aim of this paper is to present the HB-tES training and supervision program, a tele-supervised, instructional, and evaluation program to teach laypersons how to administer HB-tES to a participant and to provide a standardized framework for remote monitoring of participants by teaching staff. The secondary aim is to present early pilot data on the feasibility and effectiveness of the training portion of the program based on its implementation in 379 sessions between two pilot clinical trials. MATERIALS AND METHODS The program includes instructional materials, standardized tele-supervised hands-on practice sessions, and a system for remote supervision of participants by teaching staff. Nine laypersons completed the training program. Data on the feasibility and effectiveness of the program were collected. RESULTS No adverse events were reported during the training or any of the HB-tES sessions after the training. All laypersons successfully completed the training. The nine laypersons reported being satisfied with the training program and confident in their tES administration capabilities. This was consistent with laypersons requiring technical assistance from teaching staff very infrequently during the 379 completed sessions. The average adherence rate between all administrators was >98%, with seven of nine administrators having 100% adherence to the scheduled sessions. CONCLUSIONS These findings indicate that the HB-tES program is effective and is associated with participant satisfaction. SIGNIFICANCE We hope that the remote nature of this training program will facilitate increased accessibility to HB-tES research for participants of different demographics and locations. This program, designed for easy adaptation to different HB-tES research applications and devices, also is accessible online. The adoption of this program is expected to facilitate uniformity of study methods among future HB-tES studies and thereby accelerate the pace of tES intervention discovery.
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Affiliation(s)
- Davide Cappon
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA; Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA.
| | - Tim den Boer
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA
| | - Nicole LaGanke
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA
| | - Rachel Fox
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA; Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, USA
| | - Marina Brozgol
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, and Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA; Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
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Ruffini G, Salvador R, Castaldo F, Baleeiro T, Camprodon JA, Chopra M, Cappon D, Pascual-Leone A. Multichannel tDCS with Advanced Targeting for Major Depressive Disorder: A Tele-Supervised At-Home Pilot Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.04.24303508. [PMID: 38496607 PMCID: PMC10942536 DOI: 10.1101/2024.03.04.24303508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Introduction Proof-of-principle human studies suggest that transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) may improve depression severity. This open-label multicenter study tested remotely supervised multichannel tDCS delivered at home in patients (N=35) with major depressive disorder (MDD). The primary aim was to assess the feasibility and safety of our protocol. As an exploratory aim, we evaluated therapeutic efficacy: the primary efficacy measure was the median percent change from baseline to the end of the 4-week post-treatment follow-up period in the observer-rated Montgomery-Asberg Depression Mood Rating Scale (MADRS). Methods Participants received 37 at-home stimulation sessions (30 minutes each) of specifically designed multichannel tDCS targeting the left DLPFC administered over eight weeks (4 weeks of daily treatments plus 4 weeks of taper), with a follow-up period of 4 weeks following the final stimulation session. The stimulation montage (electrode positions and currents) was optimized by employing computational models of the electric field generated by multichannel tDCS using available structural data from a similar population (group optimization). Conducted entirely remotely, the study employed the MADRS for assessment at baseline, at weeks 4 and 8 during treatment, and at 4-week follow-up visits. Results 34 patients (85.3% women) with a mean age of 59 years, a diagnosis of MDD according to DSM-5 criteria, and a MADRS score ≥20 at the time of study enrolment completed all study visits. At baseline, the mean time since MDD diagnosis was 24.0 (SD 19.1) months. Concerning compliance, 85% of the participants (n=29) completed the complete course of 37 stimulation sessions at home, while 97% completed at least 36 sessions. No detrimental effects were observed, including suicidal ideation and/or behavior. The study observed a median MADRS score reduction of 64.5% (48.6, 72.4) 4 weeks post-treatment (Hedge's g = -3.1). We observed a response rate (≥ 50% improvement in MADRS scores) of 72.7% (n=24) from baseline to the last visit 4 weeks post-treatment. Secondary measures reflected similar improvements. Conclusions These results suggest that remotely supervised and supported multichannel home-based tDCS is safe and feasible, and antidepressant efficacy motivates further appropriately controlled clinical studies.
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Le Bars T, Bulteau S, Bonnot O, Gollier-Briant F, Prevotel A, Choneau D, Grymaszewski C, Riche VP, Rothärmel M, Poulet E, Sauvaget A, Laurin A. Home-based transcranial direct current stimulation in schizophrenia: Systematic literature review, a teenager case report with cost-utility analysis. Schizophr Res 2024; 267:441-443. [PMID: 38643724 DOI: 10.1016/j.schres.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 03/15/2024] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Tanguy Le Bars
- University of Nantes, CHU Nantes, F-44000 Nantes, France
| | - Samuel Bulteau
- University of Nantes, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France.
| | - Olivier Bonnot
- University of Nantes, CHU Nantes, Laboratoire de psychologie des Pays de la Loire, LPPL, UR 4638, F-44000 Nantes, France.
| | | | | | | | | | - Valéry-Pierre Riche
- University of Nantes, Research and Innovation Direction, CHU Nantes, F-44000 Nantes, France.
| | - Maud Rothärmel
- University Department of Psychiatry, Therapeutic Centre of Excellence, Institute of Psychiatry - Rouvray Hospital Centre, F-76300 Sotteville-lès-Rouen, France.
| | - Emmanuel Poulet
- Department of Emergency Psychiatry, Edouard Herriot Hospital, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, F-69500 Bron, France.
| | - Anne Sauvaget
- University of Nantes, CHU Nantes, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France.
| | - Andrew Laurin
- University of Nantes, CHU Nantes, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France.
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Tseng SC, Cherry D, Ko M, Fisher SR, Furtado M, Chang SH. The effects of combined transcranial brain stimulation and a 4-week visuomotor stepping training on voluntary step initiation in persons with chronic stroke-a pilot study. Front Neurol 2024; 15:1286856. [PMID: 38450075 PMCID: PMC10915046 DOI: 10.3389/fneur.2024.1286856] [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: 08/31/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
Purpose Evidence suggests that transcranial direct current stimulation (tDCS) can enhance motor performance and learning of hand tasks in persons with chronic stroke (PCS). However, the effects of tDCS on the locomotor tasks in PCS are unclear. This pilot study aimed to: (1) determine aggregate effects of anodal tDCS combined with step training on improvements of the neural and biomechanical attributes of stepping initiation in a small cohort of persons with chronic stroke (PCS) over a 4-week training program; and (2) assess the feasibility and efficacy of this novel approach for improving voluntary stepping initiation in PCS. Methods A total of 10 PCS were randomly assigned to one of two training groups, consisting of either 12 sessions of VST paired with a-tDCS (n = 6) or sham tDCS (s-tDCS, n = 4) over 4 weeks, with step initiation (SI) tests at pre-training, post-training, 1-week and 1-month follow-ups. Primary outcomes were: baseline vertical ground reaction force (B-vGRF), response time (RT) to initiate anticipatory postural adjustment (APA), and the retention of B-VGRF and RT. Results a-tDCS paired with a 4-week VST program results in a significant increase in paretic weight loading at 1-week follow up. Furthermore, a-tDCS in combination with VST led to significantly greater retention of paretic BWB compared with the sham group at 1 week post-training. Clinical implications The preliminary findings suggest a 4-week VST results in improved paretic limb weight bearing (WB) during SI in PCS. Furthermore, VST combined with a-tDCS may lead to better retention of gait improvements (NCT04437251) (https://classic.clinicaltrials.gov/ct2/show/NCT04437251).
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Affiliation(s)
- Shih-Chiao Tseng
- Neuromechanics Laboratory, Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX, United States
| | - Dana Cherry
- Neuromechanics Laboratory, Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX, United States
| | - Mansoo Ko
- Neuromechanics Laboratory, Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX, United States
| | - Steven R. Fisher
- Neuromechanics Laboratory, Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX, United States
| | - Michael Furtado
- Department of Physical Therapy, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | - Shuo-Hsiu Chang
- Neuromuscular Plasticity Laboratory, Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, United States
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Pérez-Borrego YA, Soto-León V, Brocalero-Camacho Á, Oliviero A, Carrasco-López C. A Retrospective Study on tDCS Treatment in Patients with Drug-Resistant Chronic Pain. Biomedicines 2024; 12:115. [PMID: 38255220 PMCID: PMC10813345 DOI: 10.3390/biomedicines12010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Background. Transcranial direct current stimulation (tDCS) of the primary motor cortex (M1) has an analgesic effect superior to a placebo in chronic pain. Some years ago, tDCS was implemented at the Hospital Nacional of Paraplegics (Toledo, Spain) to treat patients with pharmacological resistance to chronic pain. Objective. The main objectives of this study with tDCS were (1) to confirm the safety of one-year treatment; (2) to estimate the number of patients after one year in treatment; (3) to describe the effects of tDCS on the pain intensity during one-year treatment; and (4) to identify factors related to treatment success. Methods. This was a retrospective study conducted at the National Hospital for Paraplegics with 155 patients with pharmacologically resistant chronic pain. Anodal tDCS was applied over the M1 for 20 min at 1.5 mA for 10 treatment sessions from Monday to Friday (Induction phase), followed by 2-3 sessions per month (Maintenance phase). Pain intensity was assessed using a Visual Analogue Scale (VAS). Results. Anodal tDCS on M1 confirmed the reduction in the pain intensity. Moreover, 58% of outpatients completed one year of treatment. Only the VAS values obtained during the baseline influenced the response to treatment. Patients with a very high VAS at the baseline were more likely to not respond adequately to tDCS treatment. Conclusions. Anodal tDCS over M1 is an adequate therapy (safe and efficient) to treat drug-resistant chronic pain. Moreover, pain intensity at the start of treatment could be a predictor of patients' continuity with tDCS for at least one year.
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Affiliation(s)
- Yolanda A. Pérez-Borrego
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45071 Toledo, Spain; (V.S.-L.); (Á.B.-C.); (A.O.)
| | - Vanesa Soto-León
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45071 Toledo, Spain; (V.S.-L.); (Á.B.-C.); (A.O.)
| | - Ángela Brocalero-Camacho
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45071 Toledo, Spain; (V.S.-L.); (Á.B.-C.); (A.O.)
- Unidad de Neurología, Hospital de Parapléjicos, SESCAM, 45071 Toledo, Spain
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45071 Toledo, Spain; (V.S.-L.); (Á.B.-C.); (A.O.)
- Unidad de Neurología, Hospital de Parapléjicos, SESCAM, 45071 Toledo, Spain
- Hospital Los Madroños, 28690 Brunete, Spain
| | - Carmen Carrasco-López
- Internet of Things and People, University of Malmö, 211 19 Malmö, Sweden
- Department of Anatomy, University of Seville, 41009 Seville, Spain
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Kumpf U, Ezim H, Stadler M, Burkhardt G, Palm U, Dechantsreiter E, Padberg F. Transcranial direct current stimulation as treatment for major depression in a home treatment setting (HomeDC trial): study protocol and methodology of a double-blind, placebo-controlled pilot study. Pilot Feasibility Stud 2023; 9:197. [PMID: 38102647 PMCID: PMC10722795 DOI: 10.1186/s40814-023-01423-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/21/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Transcranial direct current stimulation (tDCS) of prefrontal cortex regions has been reported to exert therapeutic effects in patients with major depressive disorder (MDD). Due to its beneficial safety profile, its easy mode of application, and its cost-effectiveness, tDCS has recently been proposed for treatment at home. This would offer new chances for regionally widespread and long-term application. However, tDCS at home must meet the new methodological challenges of handling and adherence. At the same time, data from randomized controlled trials (RCT) investigating this mode of application are still lacking. In this pilot RCT, we therefore investigate the feasibility, safety, and effectiveness of a new antidepressant tDCS application set-up. METHODS AND ANALYSIS The HomeDC trial will be conducted as a double-blind, placebo-controlled, parallel-group design trial. Thirty-two study participants with MDD will be randomly assigned to active or sham tDCS groups. Participants will self-administer prefrontal tDCS for 6 weeks. Active tDCS will be conducted with anode over F3, cathode over F4, for 5 sessions/week, with a duration of 30 min/day, and 2 mA stimulation intensity. Sham tDCS, conversely, follows an identical protocol in regard to electrode montage and timing, but with no electric stimulation between the ramp-in and ramp-out periods. Both conditions will be administered either as a monotherapy or an adjunctive treatment to a stable dose of antidepressant medication. Adjunctive magnetic resonance imaging (MRI) and electric field (E-field) modelling will be conducted at baseline. Primary outcome is feasibility based on successfully completed stimulations and drop-out rates. The intervention is considered feasible when 20 out of 30 sessions have been fully conducted by at least 75% of the participants. Effectiveness and safety will be assessed as secondary outcomes. DISCUSSION In the HomeDC trial, the technical requirements for a placebo-controlled tDCS study in a home-based treatment setting have been established. The trial addresses the crucial points of the home-based tDCS treatment approach: uniform electrode positioning, frequent monitoring of stimulation parameters, adherence, and ensuring an appropriate home treatment environment. This study will further identify constraints and drawbacks of this novel mode of treatment. TRIAL REGISTRATION www. CLINICALTRIALS gov . TRIAL REGISTRATION NUMBER NCT05172505. Registration date: 12/13/2021.
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Affiliation(s)
- Ulrike Kumpf
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Nussbaumstr. 7, 80336, Munich, Germany.
| | - Harry Ezim
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Matthias Stadler
- Faculty of Psychology and Educational Sciences, Ludwig Maximilian University Munich, Munich, Germany
| | - Gerrit Burkhardt
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Ulrich Palm
- Medicalpark Chiemseeblick, Bernau-Felden, Germany
| | - Esther Dechantsreiter
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Nussbaumstr. 7, 80336, Munich, Germany
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Koutsomitros T, Schwarz SA, van der Zee KT, Schuhmann T, Sack AT. Home-administered transcranial direct current stimulation with asynchronous remote supervision in the treatment of depression: feasibility, tolerability, and clinical effectiveness. Front Psychiatry 2023; 14:1206805. [PMID: 38025428 PMCID: PMC10652875 DOI: 10.3389/fpsyt.2023.1206805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Background Depression is an often chronic condition, characterized by wide-ranging physical, cognitive and psychosocial symptoms that can lead to disability, premature mortality or suicide. It affects 350 million people globally, yet up to 30% do not respond to traditional treatment, creating an urgent need for novel non-pharmacological treatments. This open-label naturalistic study assesses the practical feasibility, tolerability, and clinical effectiveness of home-administered transcranial direct current stimulation (tDCS) with asynchronous remote supervision, in the treatment of depression. Method Over the course of 3 weeks, 40 patients with depression received psychotherapy and half of this group also received daily bi-frontal tDCS stimulation of the dorsolateral prefrontal cortex. These patients received tDCS for 30 min per session with the anode placed over F3 and the cathode over F4, at an intensity of 2 mA for 21 consecutive days. We measured patients' level of depression symptoms at four time points using the Beck Depression Inventory, before treatment and at 1-week intervals throughout the treatment period. We monitored practical feasibility such as daily protocol compliance and tolerability including side effects, with the PlatoScience cloud-based remote supervision platform. Results Of the 20 patients in the tDCS group, 90% were able to comply with the protocol by not missing more than three of their assigned sessions, and none dropped out of the study. No serious adverse events were reported, with only 14 instances of mild to moderate side effects and two instances of scalp pain rated as severe, out of a total of 420 stimulation sessions. Patients in the tDCS group showed a significantly greater reduction in depression symptoms after 3 weeks of treatment, compared to the treatment as usual (TAU) group [t(57.2) = 2.268, p = 0.027]. The tDCS group also showed greater treatment response (50%) and depression remission rates (75%) compared to the TAU group (5 and 30%, respectively). Discussion Conclusion These findings provide a possible indication of the clinical effectiveness of home-administered tDCS for the treatment of depression, and its feasibility and tolerability in combination with asynchronous supervision.
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Affiliation(s)
- Theodoros Koutsomitros
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Greek rTMS Clinic, Medical Psychotherapeutic Centre (I.Ψ.K.), Thessaloniki, Greece
- Institute of Psychotherapy, Medical Psychotherapeutic Centre (I.Ψ.K.), Thessaloniki, Greece
| | - Sandra A. Schwarz
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Kenneth T. van der Zee
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Donders Institute, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, Netherlands
| | - Teresa Schuhmann
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Brain Imaging Centre (MBIC), Maastricht University, Maastricht, Netherlands
| | - Alexander T. Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Brain Imaging Centre (MBIC), Maastricht University, Maastricht, Netherlands
- School for Mental Health and Neuroscience, Brain and Nerve Centre, Maastricht University Medical Centre, Maastricht, Netherlands
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11
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Kumpf U, Palm U, Eder J, Ezim H, Stadler M, Burkhardt G, Dechantsreiter E, Padberg F. TDCS at home for depressive disorders: an updated systematic review and lessons learned from a prematurely terminated randomized controlled pilot study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1403-1420. [PMID: 37191697 PMCID: PMC10185954 DOI: 10.1007/s00406-023-01620-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
The application of transcranial direct current stimulation (tDCS) at home for the treatment of major depressive disorder (MDD) is the subject of current clinical trials. This is due to its positive safety profile, cost-effectiveness, and potential scalability for a wide outreach in clinical practice. Here, we provide a systematic review of the available studies and also a report on the results of a randomized controlled trial (RCT) on tDCS at home for the treatment of MDD. This trial had to be prematurely terminated due to safety concerns. The HomeDC trial is a double-blinded, placebo-controlled, parallel-group study. Patients with MDD (DSM-5) were randomized to active or sham tDCS. Patients conducted tDCS at home for 6 weeks with 5 sessions/week (30 min at 2 mA) anode over F3, cathode over F4. Sham tDCS resembled active tDCS, with ramp-in and ramp-out periods, but without intermittent stimulation. The study was prematurely terminated due to an accumulation of adverse events (AEs, skin lesions), so that only 11 patients were included. Feasibility was good. Safety monitoring was not sufficient enough to detect or prevent AEs within an appropriate timeframe. Regarding antidepressant effects, the reduction in depression scales over time was significant. However, active tDCS was not superior to sham tDCS in this regard. Both the conclusions from this review and the HomeDC trial show that there are several critical issues with the use of tDCS at home that need to be addressed. Nevertheless the array of transcranial electric simulation (TES) methods that this mode of application offers, including tDCS, is highly interesting and warrants further investigation in high quality RCTs. TRIAL REGISTRATION www. CLINICALTRIALS gov . TRIAL REGISTRATION NUMBER NCT05172505. Registration date: 12/13/2021, https://clinicaltrials.gov/ct2/show/NCT05172505 . *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers) **If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71 . For more information, visit: http://www.prisma-statement.org/.
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Affiliation(s)
- Ulrike Kumpf
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany.
| | - Ulrich Palm
- Medicalpark Chiemseeblick, Bernau-Felden, Germany
| | - Julia Eder
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Harry Ezim
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Matthias Stadler
- Faculty of Psychology and Educational Sciences Ludwig Maximilian University Munich, Munich, Germany
| | - Gerrit Burkhardt
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Esther Dechantsreiter
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany
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12
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Windel F, Gardier RMM, Fourchard G, Viñals R, Bavelier D, Padberg FJ, Rancans E, Bonne O, Nahum M, Thiran JP, Morishita T, Hummel FC. Computer vision-based algorithm to sUppoRt coRrect electrode placemeNT (CURRENT) for home-based electric non-invasive brain stimulation. Clin Neurophysiol 2023; 153:57-67. [PMID: 37454564 DOI: 10.1016/j.clinph.2023.06.009] [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: 10/29/2022] [Revised: 03/29/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Home-based non-invasive brain stimulation (NIBS) has been suggested as an adjunct treatment strategy for neuro-psychiatric disorders. There are currently no available solutions to direct and monitor correct placement of the stimulation electrodes. To address this issue, we propose an easy-to-use digital tool to support patients for self-application. METHODS We recruited 36 healthy participants and compared their cap placement performance with the one of a NIBS-expert investigator. We tested participants' placement accuracy with instructions before (Pre) and after the investigator's placement (Post), as well as participants using the support tool (CURRENT). User experience (UX) and confidence were further evaluated. RESULTS Permutation tests demonstrated a smaller deviation within the CURRENT compared with Pre cap placement (p = 0.02). Subjective evaluation of ease of use and usefulness of the tool were vastly positive (8.04 out of 10). CURRENT decreased the variability of performance, ensured placement within the suggested maximum of deviation (10 mm) and supported confidence of correct placement. CONCLUSIONS This study supports the usability of this novel technology for correct electrode placement during self-application in home-based settings. SIGNIFICANCE CURRENT provides an exciting opportunity to promote home-based, self-applied NIBS as a safe, high-frequency treatment strategy that can be well integrated in patients' daily lives.
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Affiliation(s)
- Fabienne Windel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL Valais, Sion, Switzerland
| | - Rémy Marc M Gardier
- Signal Processing Laboratory 5 (LTS5), School of Engineering, EPFL, Lausanne, Switzerland
| | - Gaspard Fourchard
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL Valais, Sion, Switzerland
| | - Roser Viñals
- Signal Processing Laboratory 5 (LTS5), School of Engineering, EPFL, Lausanne, Switzerland
| | - Daphne Bavelier
- Department of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Frank Johannes Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany; NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Germany
| | - Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia; Riga Centre of Psychiatry and Addiction Disorders, Riga, Latvia
| | - Omer Bonne
- Hadassah Medical Center, Jerusalem, Israel
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Jean-Philippe Thiran
- Signal Processing Laboratory 5 (LTS5), School of Engineering, EPFL, Lausanne, Switzerland; Radiology Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Takuya Morishita
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL Valais, Sion, Switzerland
| | - Friedhelm Christoph Hummel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL Valais, Sion, Switzerland; Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland.
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13
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Chung J, Kim CT, Lee J, Lee E, Jung KI, Yoo WK, Oh BS, Kwon OJ, Kim YJ, Ohn SH. Factors Affecting Participation in Telerehabilitation Using Transcranial Direct Current Stimulation for Patients with Poststroke Paralysis in South Korea. Telemed J E Health 2023; 29:1404-1411. [PMID: 36695668 DOI: 10.1089/tmj.2022.0452] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: The coronavirus disease 2019 pandemic has expanded noncontact health care systems worldwide. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technology that enables treatment monitoring under remote supervision. We investigated the factors affecting patients' decision to participate in telerehabilitation (TR) using tDCS for motor function recovery after suffering a stroke. Materials and Methods: Four medical institutions surveyed 156 patients with poststroke paralysis. The participants were asked whether they would participate in TR therapy using tDCS in the future. We performed logistic regression analysis to examine the factors-demographic data, stroke characteristics, arm function, gait, and cognitive function-that influenced participants' decisions. Results: Of the participants, 66% (103/156) reported that they would participate in TR using tDCS in the future. Participants' monthly salary was a single significant independent factor influencing their decision to participate. Those earning greater than 5 million KRW (4,000 USD) were more likely to engage in TR via tDCS than those earning less than 1 million KRW (800 USD). The most common barriers to participation in telemedicine included the preference for face-to-face treatment and unfamiliarity. The expected medical expenses of TR using tDCS were 46,154 KRW (37 USD) per session. Conclusions: Most participants with poststroke paralysis responded positively to TR using tDCS for hand function recovery. For telemedicine to work effectively in a situation wherein face-to-face rehabilitation is impossible, prior discussion at the governmental level is essential for determining medical finances.
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Affiliation(s)
- Jane Chung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Clara Tammy Kim
- Institute of Life and Death Studies, Hallym University, Chuncheon, Republic of Korea
| | - Jeongeun Lee
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Eunjee Lee
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Kwang-Ik Jung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Bum Seok Oh
- Department of Physical Medicine and Rehabilitation, Shiny Sky Rehabilitation Hospital, Anyang, Republic of Korea
| | - Oh Joong Kwon
- Department of General Surgery, Avens Rehabilitation Hospital, Anyang, Republic of Korea
| | - Yu Je Kim
- Department of Physical Medicine and Rehabilitation, Green Rehabilitation Hospital, Anyang, Republic of Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
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14
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Klichowski M, Wicher A, Kruszwicka A, Golebiewski R. Reverse effect of home-use binaural beats brain stimulation. Sci Rep 2023; 13:11079. [PMID: 37422545 PMCID: PMC10329717 DOI: 10.1038/s41598-023-38313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023] Open
Abstract
Binaural beats brain stimulation is a popular strategy for supporting home-use cognitive tasks. However, such home-use brain stimulation may be neutral to cognitive processes, and any intellectual improvement may be only a placebo effect. Thus, without belief in it, it may bring no benefits. Here we test 1000 individuals at their homes as they perform a two-part fluid intelligence test. Some took the second part listening to binaural beats, while others took it in silence or listening to other sounds. The binaural beats group was divided into three subgroups. The first one was informed that they would listen to sounds that improve the brain's work, the second that neutral sounds, and the third that some sounds the nature of which was not defined. We found that listening to binaural beats was not neutral, as it dramatically deteriorated the score irrespective of the condition. Silence or other sounds had no effect. Thus, home-use binaural beats brain stimulation brings reverse effects to those assumed: instead of supporting the effectiveness of cognitive activities, it may weaken them.
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Affiliation(s)
- Michal Klichowski
- Cognitive Neuroscience Center, Adam Mickiewicz University, Poznan, Poland.
- Learning Laboratory, Faculty of Educational Studies, Adam Mickiewicz University, Poznan, Poland.
| | - Andrzej Wicher
- Cognitive Neuroscience Center, Adam Mickiewicz University, Poznan, Poland
- Department of Acoustics, Faculty of Physics, Adam Mickiewicz University, Poznan, Poland
| | - Agnieszka Kruszwicka
- Cognitive Neuroscience Center, Adam Mickiewicz University, Poznan, Poland
- Learning Laboratory, Faculty of Educational Studies, Adam Mickiewicz University, Poznan, Poland
| | - Roman Golebiewski
- Cognitive Neuroscience Center, Adam Mickiewicz University, Poznan, Poland
- Department of Acoustics, Faculty of Physics, Adam Mickiewicz University, Poznan, Poland
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15
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Jones KT, Ostrand AE, Gazzaley A, Zanto TP. Enhancing cognitive control in amnestic mild cognitive impairment via at-home non-invasive neuromodulation in a randomized trial. Sci Rep 2023; 13:7435. [PMID: 37156876 PMCID: PMC10167304 DOI: 10.1038/s41598-023-34582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 05/03/2023] [Indexed: 05/10/2023] Open
Abstract
Individuals with multi-domain amnestic mild cognitive impairment (md-aMCI) have an elevated risk of dementia and need interventions that may retain or remediate cognitive function. In a feasibility pilot study, 30 older adults aged 60-80 years with md-aMCI were randomized to 8 sessions of transcranial alternating current stimulation (tACS) with simultaneous cognitive control training (CCT). The intervention took place within the participant's home without direct researcher assistance. Half of the participants received prefrontal theta tACS during CCT and the other half received control tACS. We observed high tolerability and adherence for at-home tACS + CCT. Within 1-week, only those who received theta tACS exhibited improved attentional abilities. Neuromodulation is feasible for in-home settings, which can be conducted by the patient, thereby enabling treatment in difficult to reach populations. TACS with CCT may facilitate cognitive control abilities in md-aMCI, but research in a larger population is needed to validate efficacy.
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Affiliation(s)
- Kevin T Jones
- Department of Neurology, University of California-San Francisco, 675 Nelson Rising Ln, San Francisco, CA, 94158, USA.
- Neuroscape, University of California-San Francisco, 675 Nelson Rising Ln, San Francisco, CA, 94158, USA.
- Sandler Neurosciences Center, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA.
| | - Avery E Ostrand
- Department of Neurology, University of California-San Francisco, 675 Nelson Rising Ln, San Francisco, CA, 94158, USA
- Neuroscape, University of California-San Francisco, 675 Nelson Rising Ln, San Francisco, CA, 94158, USA
| | - Adam Gazzaley
- Department of Neurology, University of California-San Francisco, 675 Nelson Rising Ln, San Francisco, CA, 94158, USA
- Neuroscape, University of California-San Francisco, 675 Nelson Rising Ln, San Francisco, CA, 94158, USA
- Departments of Physiology and Psychiatry, University of California-San Francisco, 675 18th St, San Francisco, CA, 94143, USA
| | - Theodore P Zanto
- Department of Neurology, University of California-San Francisco, 675 Nelson Rising Ln, San Francisco, CA, 94158, USA
- Neuroscape, University of California-San Francisco, 675 Nelson Rising Ln, San Francisco, CA, 94158, USA
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16
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Davis MC, Fitzgerald PB, Bailey NW, Sullivan C, Stout JC, Hill AT, Hoy KE. Effects of medial prefrontal transcranial alternating current stimulation on neural activity and connectivity in people with Huntington's disease and neurotypical controls. Brain Res 2023; 1811:148379. [PMID: 37121424 DOI: 10.1016/j.brainres.2023.148379] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/30/2023] [Accepted: 04/25/2023] [Indexed: 05/02/2023]
Abstract
We investigated the effects of transcranial alternating current stimulation (tACS) targeted to the medial prefrontal cortex (mPFC) on resting electroencephalographic (EEG) indices of oscillatory power, aperiodic exponent and offset, and functional connectivity in 22 late premanifest and early manifest stage individuals with HD and 20 neurotypical controls. Participants underwent three 20-minute sessions of tACS at least 72 hours apart; one session at alpha frequency (either each participant's Individualised Alpha Frequency (IAF), or 10Hz when an IAF was not detected); one session at delta frequency (2Hz); and a session of sham tACS. Session order was randomised and counterbalanced across participants. EEG recordings revealed a reduction of the spectral exponent ('flattening' of the 1/f slope) of the eyes-open aperiodic signal in participants with HD following alpha-tACS, suggestive of an enhancement in excitatory tone. Contrary to expectation, there were no changes in oscillatory power or functional connectivity in response to any of the tACS conditions in the participants with HD. By contrast, alpha-tACS increased delta power in neurotypical controls, who further demonstrated significant increases in theta power and theta functional connectivity in response to delta-tACS. This study contributes to the rapidly growing literature on the potential experimental and therapeutic applications of tACS by examining neurophysiological outcome measures in people with HD as well as neurotypical controls.
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Affiliation(s)
- Marie-Claire Davis
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Victoria Australia.
| | - Paul B Fitzgerald
- School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
| | - Neil W Bailey
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia; Monarch Research Institute Monarch Mental Health Group, Sydney, NSW, Australia
| | - Caley Sullivan
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia
| | - Julie C Stout
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Aron T Hill
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Australia
| | - Kate E Hoy
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; The Bionics Institute of Australia, 384-388 Albert St, East Melbourne, VIC, 3002, Australia
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17
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Davis MC, Hill AT, Fitzgerald PB, Bailey NW, Sullivan C, Stout JC, Hoy KE. Medial prefrontal transcranial alternating current stimulation for apathy in Huntington's disease. Prog Neuropsychopharmacol Biol Psychiatry 2023; 126:110776. [PMID: 37120005 DOI: 10.1016/j.pnpbp.2023.110776] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Abstract
We investigated the effects of transcranial alternating current stimulation (tACS) targeted to the bilateral medial prefrontal cortex (mPFC) and administered at either delta or alpha frequencies, on brain activity and apathy in people with Huntington's disease (HD) (n = 17). Given the novelty of the protocol, neurotypical controls (n = 20) were also recruited. All participants underwent three 20-min sessions of tACS; one session at alpha frequency (Individualised Alpha Frequency (IAF), or 10 Hz when an IAF was not detected); one session at delta frequency (2 Hz); and a session of sham tACS. Participants completed the Monetary Incentive Delay (MID) task with simultaneous recording of EEG immediately before and after each tACS condition. The MID task presents participants with cues signalling potential monetary gains or losses that increase activity in key regions of the cortico-basal ganglia-thalamocortical networks, with dysfunction of the latter network being implicated in the pathophysiology of apathy. We used the P300 and Contingent Negative Variation (CNV) event-related potentials elicited during the MID task as markers of mPFC engagement. HD participants' CNV amplitude significantly increased in response to alpha-tACS, but not delta-tACS or sham. Neurotypical controls' P300 and CNV were not modulated by any of the tACS conditions, but they did demonstrate a significant decrease in post-target response times following alpha-tACS. We present this as preliminary evidence of the ability of alpha-tACS to modulate brain activity associated with apathy in HD.
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Affiliation(s)
- Marie-Claire Davis
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Victoria, Australia.
| | - Aron T Hill
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Australia
| | - Paul B Fitzgerald
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
| | - Neil W Bailey
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia; Monarch Research Institute Monarch Mental Health Group, Sydney, NSW, Australia
| | - Caley Sullivan
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia
| | - Julie C Stout
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Kate E Hoy
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; The Bionics Institute of Australia, 384-388 Albert St, East Melbourne, VIC 3002, Australia
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18
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Transcranial Direct Current Stimulation (tDCS) in Pediatric Populations—– Voices from Typically Developing Children and Adolescents and their Parents. NEUROETHICS-NETH 2023. [DOI: 10.1007/s12152-022-09507-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Transcranial direct current stimulation (tDCS) is a brain stimulation technique currently being researched as an alternative or complimentary treatment for various neurological disorders. There is little knowledge about experiences of the participants of tDCS clinical research, especially from pediatric studies.
Methods
An interview study with typically developing minors (n = 19, mean age 13,66 years) participating in a tDCS study, and their parents (n = 18) was conducted to explore their views and experiences and inform the ethical analysis.
Results
Children (10–13 years old) and adolescents (14–18 years old) reported good experiences with the stimulation. Next to financial incentives, main motives to participate in the study were curiosity and the possibility to help develop treatments for children affected by neurological disorders. They could also see a potential of using tDCS in a non-medical setting, especially regarding the provision of equal opportunity, e.g. in education. Parents also presented a positive attitude towards tDCS and their children participation in the basic research study. Nevertheless, their understanding of tDCS was rather poor. Even though many of them understood the techniques, they often did not see the link between the (current) lack of side effects and an absence of longitudinal studies. Parents were also cautious about using tDCS for non-medical/enhancement purposes.
Conclusions
The study findings show a need for more transparent information about the state of the art of tDCS, its function and what it might be able to offer, especially considering the good acceptability of tDCS.
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19
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Satish S. Cautious optimism regarding the use of home-based neuromodulation to treat depression. Lancet Psychiatry 2023; 10:156-157. [PMID: 36724797 DOI: 10.1016/s2215-0366(23)00028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/31/2023]
Affiliation(s)
- Suhas Satish
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
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Mucci V, Demori I, Browne CJ, Deblieck C, Burlando B. Fibromyalgia in Pregnancy: Neuro-Endocrine Fluctuations Provide Insight into Pathophysiology and Neuromodulation Treatment. Biomedicines 2023; 11:biomedicines11020615. [PMID: 36831148 PMCID: PMC9953487 DOI: 10.3390/biomedicines11020615] [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: 01/06/2023] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Fibromyalgia (FM) is a chronic pain disorder with unclear pathophysiological mechanisms, which leads to challenges in patient management. In addition to pain, the disorder presents with a broad range of symptoms, such as sleep disruption, chronic fatigue, brain fog, depression, muscle stiffness, and migraine. FM has a considerable female prevalence, and it has been shown that symptoms are influenced by the menstrual cycle and periods of significant hormonal and immunological changes. There is increasing evidence that females with FM experience an aggravation of symptoms in pregnancy, particularly during the third trimester and after childbirth. In this perspective paper, we focus on the neuro-endocrine interactions that occur between progesterone, allopregnanolone, and cortisol during pregnancy, and propose that they align with our previously proposed model of FM pathogenesis based on GABAergic "weakening" in a thalamocortical neural loop system. Based on our hypothesis, we introduce the possibility of utilizing transcranial direct current stimulation (tDCS) as a non-invasive treatment potentially capable of exerting sex-specific effects on FM patients.
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Affiliation(s)
- Viviana Mucci
- School of Science, Western Sydney University, Campbelltown, NSW 2560, Australia
- Correspondence:
| | - Ilaria Demori
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genova, Corso Europa, 26, 16132 Genova, Italy
| | - Cherylea J. Browne
- School of Science, Western Sydney University, Campbelltown, NSW 2560, Australia
- Translational Neuroscience Facility, School of Medical Sciences, UNSW Sydney, Kensington, NSW 2052, Australia
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Choi Deblieck
- Antwerp Management School, University of Antwerp, Boogkeers 5, 2000 Antwerp, Belgium
| | - Bruno Burlando
- Department of Pharmacy, DIFAR, University of Genova, Viale Benedetto XV, 3, 16132 Genova, Italy
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21
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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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22
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Satorres E, Escudero Torrella J, Real E, Pitarque A, Delhom I, Melendez JC. Home-based transcranial direct current stimulation in mild neurocognitive disorder due to possible Alzheimer's disease. A randomised, single-blind, controlled-placebo study. Front Psychol 2023; 13:1071737. [PMID: 36660288 PMCID: PMC9844131 DOI: 10.3389/fpsyg.2022.1071737] [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: 10/16/2022] [Accepted: 12/02/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction Mild neurocognitive disorder (mNCD), a pre-dementia stage close to Mild Cognitive Impairment, shows a progressive and constant decline in the memory domain. Of the non-pharmacological therapeutic interventions that may help to decelerate the neurodegenerative progress, transcranial direct current stimulation (tDCS) shows beneficial effects on the learning curve, immediate recall, immediate verbal memory and executive functions. The purpose of this research was to study the effect of tDCS on general cognition, immediate and delayed memory and executive functions by comparing an active group with a placebo group of mNCD patients. Methods Participants were 33 mNCD due to possible AD, randomly assigned to two groups: 17 active tDCS and 16 placebo tDCS. Ten sessions of tDCS were conducted over the left dorsolateral prefrontal cortex. Several neuropsychological scales were administered to assess the primary outcome measures of general cognitive function, immediate and delayed memory and learning ability, whereas the secondary outcome measures included executive function tests. All participants were evaluated at baseline and at the end of the intervention. Mixed ANOVAs were performed. Results Significant effects were obtained on general cognitive function, immediate and delayed memory and learning ability, with increases in scores in the active tDCS group. However, there were no significant effects on executive function performance. Conclusion The present study demonstrated the effectiveness of tDCS in an active tDCS group, compared to a placebo group, in improving general cognition and immediate and delayed memory, as previous studies found. Taken together, our data suggest that tDCS is a simple, painless, reproducible and easy technique that is useful for treating cognitive alterations found in neurodegenerative diseases.
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Affiliation(s)
| | | | - Elena Real
- Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | - Iraida Delhom
- Faculty of Psychology, Jaume I University, Castellón de La Plana, Spain
| | - Juan C. Melendez
- Faculty of Psychology, University of Valencia, Valencia, Spain,*Correspondence: Juan C. Melendez,
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23
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Santana K, França E, Sato J, Silva A, Queiroz M, de Farias J, Rodrigues D, Souza I, Ribeiro V, Caparelli-Dáquer E, Teixeira AL, Charvet L, Datta A, Bikson M, Andrade S. Non-invasive brain stimulation for fatigue in post-acute sequelae of SARS-CoV-2 (PASC). Brain Stimul 2023; 16:100-107. [PMID: 36693536 PMCID: PMC9867562 DOI: 10.1016/j.brs.2023.01.1672] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND and purpose: Fatigue is among the most common persistent symptoms following post-acute sequelae of Sars-COV-2 infection (PASC). The current study investigated the potential therapeutic effects of High-Definition transcranial Direct Current Stimulation (HD-tDCS) associated with rehabilitation program for the management of PASC-related fatigue. METHODS Seventy patients with PASC-related fatigue were randomized to receive 3 mA or sham HD-tDCS targeting the left primary motor cortex (M1) for 30 min paired with a rehabilitation program. Each patient underwent 10 sessions (2 sessions/week) over five weeks. Fatigue was measured as the primary outcome before and after the intervention using the Modified Fatigue Impact Scale (MFIS). Pain level, anxiety severity and quality of life were secondary outcomes assessed, respectively, through the McGill Questionnaire, Hamilton Anxiety Rating Scale (HAM-A) and WHOQOL. RESULTS Active HD-tDCS resulted in significantly greater reduction in fatigue compared to sham HD-tDCS (mean group MFIS reduction of 22.11 points vs 10.34 points). Distinct effects of HD-tDCS were observed in fatigue domains with greater effect on cognitive (mean group difference 8.29 points; effect size 1.1; 95% CI 3.56-13.01; P < .0001) and psychosocial domains (mean group difference 2.37 points; effect size 1.2; 95% CI 1.34-3.40; P < .0001), with no significant difference between the groups in the physical subscale (mean group difference 0.71 points; effect size 0.1; 95% CI 4.47-5.90; P = .09). Compared to sham, the active HD-tDCS group also had a significant reduction in anxiety (mean group difference 4.88; effect size 0.9; 95% CI 1.93-7.84; P < .0001) and improvement in quality of life (mean group difference 14.80; effect size 0.7; 95% CI 7.87-21.73; P < .0001). There was no significant difference in pain (mean group difference -0.74; no effect size; 95% CI 3.66-5.14; P = .09). CONCLUSION An intervention with M1 targeted HD-tDCS paired with a rehabilitation program was effective in reducing fatigue and anxiety, while improving quality of life in people with PASC.
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Affiliation(s)
| | | | - João Sato
- Center of Mathematics, Computing and Cognition, Federal University of ABC, Santo André, Brazil
| | - Ana Silva
- Federal University of Paraíba, João Pessoa, Brazil
| | | | | | | | - Iara Souza
- Federal University of Paraíba, João Pessoa, Brazil
| | - Vanessa Ribeiro
- Department of Health, Government of Paraíba, João Pessoa, Brazil
| | - Egas Caparelli-Dáquer
- Nervous System Electric Stimulation Lab, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Antonio L. Teixeira
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, United States,Faculdade Santa Casa BH, Belo Horizonte, Brazil
| | - Leigh Charvet
- Department of Neurology, New York University Langone Health, New York, United States
| | - Abhishek Datta
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, United States,Research & Development, Soterix Medical, Inc., New York, United States
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, United States
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24
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Examining the synergistic effects of a cognitive control video game and a home-based, self-administered non-invasive brain stimulation on alleviating depression: the DiSCoVeR trial protocol. Eur Arch Psychiatry Clin Neurosci 2023; 273:85-98. [PMID: 36271928 PMCID: PMC9589526 DOI: 10.1007/s00406-022-01464-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
Enhanced behavioral interventions are gaining increasing interest as innovative treatment strategies for major depressive disorder (MDD). In this study protocol, we propose to examine the synergistic effects of a self-administered home-treatment, encompassing transcranial direct current stimulation (tDCS) along with a video game based training of attentional control. The study is designed as a two-arm, double-blind, randomized and placebo-controlled multi-center trial (ClinicalTrials.gov: NCT04953208). At three study sites (Israel, Latvia, and Germany), 114 patients with a primary diagnosis of MDD undergo 6 weeks of intervention (30 × 30 min sessions). Patients assigned to the intervention group receive active tDCS (anode F3 and cathode F4; 2 mA intensity) and an action-like video game, while those assigned to the control group receive sham tDCS along with a control video game. An electrode-positioning algorithm is used to standardize tDCS electrode positioning. Participants perform their designated treatment at the clinical center (sessions 1-5) and continue treatment at home under remote supervision (sessions 6-30). The endpoints are feasibility (primary) and safety, treatment efficacy (secondary, i.e., change of Montgomery-Åsberg Depression Rating Scale (MADRS) scores at week six from baseline, clinical response and remission, measures of social, occupational, and psychological functioning, quality of life, and cognitive control (tertiary). Demonstrating the feasibility, safety, and efficacy of this novel combined intervention could expand the range of available treatments for MDD to neuromodulation enhanced interventions providing cost-effective, easily accessible, and low-risk treatment options.ClinicalTrials.gov: NCT04953208.
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25
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Owens AP, Krebs C, Kuruppu S, Brem AK, Kowatsch T, Aarsland D, Klöppel S. Broadened assessments, health education and cognitive aids in the remote memory clinic. Front Public Health 2022; 10:1033515. [PMID: 36568790 PMCID: PMC9768191 DOI: 10.3389/fpubh.2022.1033515] [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: 08/31/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022] Open
Abstract
The prevalence of dementia is increasing and poses a health challenge for individuals and society. Despite the desire to know their risks and the importance of initiating early therapeutic options, large parts of the population do not get access to memory clinic-based assessments. Remote memory clinics facilitate low-level access to cognitive assessments by eschewing the need for face-to-face meetings. At the same time, patients with detected impairment or increased risk can receive non-pharmacological treatment remotely. Sensor technology can evaluate the efficiency of this remote treatment and identify cognitive decline. With remote and (partly) automatized technology the process of cognitive decline can be monitored but more importantly also modified by guiding early interventions and a dementia preventative lifestyle. We highlight how sensor technology aids the expansion of assessments beyond cognition and to other domains, e.g., depression. We also illustrate applications for aiding remote treatment and describe how remote tools can facilitate health education which is the cornerstone for long-lasting lifestyle changes. Tools such as transcranial electric stimulation or sleep-based interventions have currently mostly been used in a face-to-face context but have the potential of remote deployment-a step already taken with memory training apps. Many of the presented methods are readily scalable and of low costs and there is a range of target populations, from the worried well to late-stage dementia.
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Affiliation(s)
- Andrew P. Owens
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Christine Krebs
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sajini Kuruppu
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Anna-Katharine Brem
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom,University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland,School of Medicine, University of St. Gallen, St. Gallen, Switzerland,Centre for Digital Health Interventions, Department Management, Technology, and Economics at ETH Zurich, Zurich, Switzerland
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,*Correspondence: Stefan Klöppel
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26
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Antonenko D, Rocke M, Thams F, Hummel FC, Maceira-Elvira P, Meinzer M, Flöel A. Complementary practical considerations to home-based, remotely-controlled and independently self-applied tES combined with cognitive training. Brain Stimul 2022; 15:1351-1353. [PMID: 36191808 DOI: 10.1016/j.brs.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
- Daria Antonenko
- University Medicine Greifswald, Department of Neurology, 17475, Greifswald, Germany.
| | - Merle Rocke
- University Medicine Greifswald, Department of Neurology, 17475, Greifswald, Germany
| | - Friederike Thams
- University Medicine Greifswald, Department of Neurology, 17475, Greifswald, Germany
| | - Friedhelm C Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202, Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951, Sion, Switzerland; Clinical Neuroscience, University of Geneva Medical School, 1202, Geneva, Switzerland
| | - Pablo Maceira-Elvira
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202, Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951, Sion, Switzerland; Clinical Neuroscience, University of Geneva Medical School, 1202, Geneva, Switzerland
| | - Marcus Meinzer
- University Medicine Greifswald, Department of Neurology, 17475, Greifswald, Germany
| | - Agnes Flöel
- University Medicine Greifswald, Department of Neurology, 17475, Greifswald, Germany
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27
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Tsapkini K. Home-Based Transcranial Direct Current Stimulation: Are We There Yet? Stroke 2022; 53:3002-3003. [PMID: 35975665 PMCID: PMC9529808 DOI: 10.1161/strokeaha.122.040113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kyrana Tsapkini
- Department of Neurology (K.T.), Johns Hopkins School of Medicine, Baltimore MD
- Department of Cognitive Science (K.T.), Johns Hopkins School of Medicine, Baltimore MD
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28
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Simpson EA, Saiote C, Sutter E, Lench DH, Ikonomidou C, Villegas MA, Gillick BT. Remotely monitored transcranial direct current stimulation in pediatric cerebral palsy: open label trial protocol. BMC Pediatr 2022; 22:566. [PMID: 36175848 PMCID: PMC9521558 DOI: 10.1186/s12887-022-03612-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 09/14/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pediatric applications of non-invasive brain stimulation using transcranial direct current stimulation (tDCS) have demonstrated its safety with few adverse events reported. Remotely monitored tDCS, as an adjuvant intervention to rehabilitation, may improve quality of life for children with cerebral palsy (CP) through motor function improvements, reduced treatment costs, and increased access to tDCS therapies. Our group previously evaluated the feasibility of a remotely monitored mock tDCS setup in which families and children successfully demonstrated the ability to follow tDCS instructional guidance. METHODS AND DESIGN Here, we designed a protocol to investigate the feasibility, safety, and tolerability of at-home active transcranial direct current stimulation in children with CP with synchronous supervision from laboratory investigators. Ten participants will be recruited to participate in the study for 5 consecutive days with the following sessions: tDCS setup practice on day 1, sham tDCS on day 2, and active tDCS on days 3-5. Sham stimulation will consist of an initial 30-second ramp up to 1.5 mA stimulation followed by a 30-second ramp down. Active stimulation will be delivered at 1.0 - 1.5 mA for 20 minutes and adjusted based on child tolerance. Feasibility will be evaluated via photographs of montage setup and the quality of stimulation delivery. Safety and tolerability will be assessed through an adverse events survey, the Box and Blocks Test (BBT) motor assessment, and a setup ease/comfort survey. DISCUSSION We expect synchronous supervision of at-home teleneuromodulation to be tolerable and safe with increasing stimulation quality over repeated sessions when following a tDCS setup previously determined to be feasible. The findings will provide opportunity for larger clinical trials exploring efficacy and illuminate the potential of remotely monitored tDCS in combination with rehabilitation interventions as a means of pediatric neurorehabilitation. This will demonstrate the value of greater accessibility of non-invasive brain stimulation interventions and ultimately offer the potential to improve care and quality of life for children and families with CP. TRIAL REGISTRATION October 8, 2021( https://clinicaltrials.gov/ct2/show/NCT05071586 ).
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Affiliation(s)
- Emma A Simpson
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA
| | - Catarina Saiote
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA
| | - Ellen Sutter
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel H Lench
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Melissa A Villegas
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA
- University of Wisconsin-Madison Pediatrics, Madison, Wisconsin, USA
| | - Bernadette T Gillick
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA.
- University of Wisconsin-Madison Pediatrics, Madison, Wisconsin, USA.
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29
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Ko MH, Yoon JY, Jo YJ, Son MN, Kim DS, Kim GW, Won YH, Park SH, Seo JH, Kim YH. Home-Based Transcranial Direct Current Stimulation to Enhance Cognition in Stroke: Randomized Controlled Trial. Stroke 2022; 53:2992-3001. [PMID: 35975663 DOI: 10.1161/strokeaha.121.037629] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a promising tool for improving post-stroke cognitive function. Home-based rehabilitation is increasingly required for patients with stroke, and additional benefits are expected if supplemented with remotely supervised tDCS (RS-tDCS). We evaluated the cognitive improvement effect and feasibility of RS-tDCS in patients with chronic stroke. METHODS Twenty-six patients with chronic stroke and cognitive impairment (Korean version of the Montreal Cognitive Assessment [K-MoCA] score <26) were randomized into real and sham RS-tDCS groups and underwent concurrent computerized cognitive training and RS-tDCS. Patients and caregivers underwent training to ensure correct tDCS self-application, were monitored, and treated 5 d/wk for 4 weeks. We investigated several cognition tests including K-MoCA, Korean version of the Dementia Rating Scale-2, Korean-Boston Naming Test, Trail Making Test, Go/No Go, and Controlled Oral Word Association Test at the end of the training sessions and one month later. Repeated-measures ANOVA was used for comparison between the groups and within each group. The adherence rate of the appropriate RS-tDCS session was also investigated. RESULTS In within-group comparison, unlike the sham group, the real group showed significant improvement in K-MoCA (Preal=0.004 versus Psham=0.132), particularly in patients with lower baseline K-MoCA (K-MoCA10-17; Preal=0.001 versus Psham=0.835, K-MoCA18-25; Preal=0.060 versus Psham=0.064) or with left hemispheric lesions (left; Preal=0.010 versus Psham=0.454, right; Preal=0.106 versus Psham=0.128). In between-group comparison, a significant difference was observed in K-MoCA in the lower baseline K-MoCA subgroup (K-MoCA10-17; Ptime×group=0.048), but no significant difference was found in other cognitive tests. The adherence rate of successful application of the RS-tDCS was 98.4%, and no serious adverse effects were detected. CONCLUSIONS RS-tDCS is a safe and feasible rehabilitation modality for post-stroke cognitive dysfunction. Specifically, RS-tDCS is effective in patients with moderate cognitive decline. Additionally, these data demonstrate the potential to enhance home-based cognitive training, although significant differences were not consistently found in between-group comparisons; therefore, further larger studies are needed. REGISTRATION URL: https://cris.nih.go.kr; Unique identifier: KCT0003427.
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Affiliation(s)
- Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea (M.-H.K., J.-Y.Y., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.).,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (M.-H.K., Y.-J.J., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.).,Translational Research & Clinical Trials Center for Medical Devices, Jeonbuk National University Hospital, Jeonju, Republic of Korea (M.-H.K., Y.-J.J., G.-W.K.)
| | - Ju-Yul Yoon
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea (M.-H.K., J.-Y.Y., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.).,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (M.-H.K., Y.-J.J., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.)
| | - Yun-Ju Jo
- Translational Research & Clinical Trials Center for Medical Devices, Jeonbuk National University Hospital, Jeonju, Republic of Korea (M.-H.K., Y.-J.J., G.-W.K.)
| | - Mi-Nam Son
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (M.-N.S., Y.-H.K.)
| | - Da-Sol Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea (M.-H.K., J.-Y.Y., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.).,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (M.-H.K., Y.-J.J., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.)
| | - Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea (M.-H.K., J.-Y.Y., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.).,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (M.-H.K., Y.-J.J., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.).,Translational Research & Clinical Trials Center for Medical Devices, Jeonbuk National University Hospital, Jeonju, Republic of Korea (M.-H.K., Y.-J.J., G.-W.K.)
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea (M.-H.K., J.-Y.Y., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.).,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (M.-H.K., Y.-J.J., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.)
| | - Sung-Hee Park
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea (M.-H.K., J.-Y.Y., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.).,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (M.-H.K., Y.-J.J., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.)
| | - Jeong-Hwan Seo
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea (M.-H.K., J.-Y.Y., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.).,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (M.-H.K., Y.-J.J., D.-S.K., G.-W.K., Y.H.W., S.-H.P., J.-H.S.)
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (M.-N.S., Y.-H.K.).,Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (Y.-H.K.)
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Thams F, Rocke M, Malinowski R, Nowak R, Grittner U, Antonenko D, Flöel A. Feasibility of Cognitive Training in Combination With Transcranial Direct Current Stimulation in a Home-Based Context (TrainStim-Home): study protocol for a randomised controlled trial. BMJ Open 2022; 12:e059943. [PMID: 35688585 PMCID: PMC9189820 DOI: 10.1136/bmjopen-2021-059943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION With the worldwide increase of life expectancy leading to a higher proportion of older adults experiencing age-associated deterioration of cognitive abilities, the development of effective and widely accessible prevention and therapeutic measures has become a priority and challenge for modern medicine. Combined interventions of cognitive training and transcranial direct current stimulation (tDCS) have shown promising results for counteracting age-associated cognitive decline. However, access to clinical centres for repeated sessions is challenging, particularly in rural areas and for older adults with reduced mobility, and lack of clinical personnel and hospital space prevents extended interventions in larger cohorts. A home-based and remotely supervised application of tDCS would make the treatment more accessible for participants and relieve clinical resources. So far, studies assessing feasibility of combined interventions with a focus on cognition in a home-based setting are rare. With this study, we aim to provide evidence for the feasibility and the effects of a multisession home-based cognitive training in combination with tDCS on cognitive functions of healthy older adults. METHODS AND ANALYSIS The TrainStim-Home trial is a monocentric, randomised, double-blind, placebo-controlled study. Thirty healthy participants, aged 60-80 years, will receive 2 weeks of combined cognitive training and anodal tDCS over left dorsolateral prefrontal cortex (target intervention), compared with cognitive training plus sham stimulation. The cognitive training will comprise a letter updating task, and the participants will be stimulated for 20 min with 1.5 mA. The intervention sessions will take place at the participants' home, and primary outcome will be the feasibility, operationalised by two-thirds successfully completed sessions per participant. Additionally, performance in the training task and an untrained task will be analysed. ETHICS AND DISSEMINATION Ethical approval was granted by the ethics committee of the University Medicine Greifswald. Results will be available through publications in peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER NCT04817124.
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Affiliation(s)
- Friederike Thams
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Merle Rocke
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Robert Malinowski
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Rafal Nowak
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
- Neuroelectrics Barcelona SL, Barcelona, Spain
| | - Ulrike Grittner
- Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daria Antonenko
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Agnes Flöel
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases, Greifswald, Germany
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Mizutani-Tiebel Y, Takahashi S, Karali T, Mezger E, Bulubas L, Papazova I, Dechantsreiter E, Stoecklein S, Papazov B, Thielscher A, Padberg F, Keeser D. Differences in electric field strength between clinical and non-clinical populations induced by prefrontal tDCS: A cross-diagnostic, individual MRI-based modeling study. Neuroimage Clin 2022; 34:103011. [PMID: 35487132 PMCID: PMC9125784 DOI: 10.1016/j.nicl.2022.103011] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/17/2022] [Accepted: 04/13/2022] [Indexed: 01/25/2023]
Abstract
MDD and SCZ showed lower prefrontal tDCS-induced e-field strengths compared to HC. Average e-field strengths did not significantly differ between MDD and SCZ patients. Inter-individual variability of e-field intensities and distribution was prominent. Inter-rater variability emphasizes the importance of standardized positioning.
Introduction Prefrontal cortex (PFC) regions are promising targets for therapeutic applications of non-invasive brain stimulation, e.g. transcranial direct current stimulation (tDCS), which has been proposed as a novel intervention for major depressive disorder (MDD) and negative symptoms of schizophrenia (SCZ). However, the effects of tDCS vary inter-individually, and dose–response relationships have not been established. Stimulation parameters are often tested in healthy subjects and transferred to clinical populations. The current study investigates the variability of individual MRI-based electric fields (e-fields) of standard bifrontal tDCS across individual subjects and diagnoses. Method The study included 74 subjects, i.e. 25 patients with MDD, 24 patients with SCZ, and 25 healthy controls (HC). Individual e-fields of a common tDCS protocol (i.e. 2 mA stimulation intensity, bifrontal anode-F3/cathode-F4 montage) were modeled by two investigators using SimNIBS (2.0.1) based on structural MRI scans. Result On a whole-brain level, the average e-field strength was significantly reduced in MDD and SCZ compared to HC, but MDD and SCZ did not differ significantly. Regions of interest (ROI) analysis for PFC subregions showed reduced e-fields in Sallet areas 8B and 9 for MDD and SCZ compared to HC, whereas there was again no difference between MDD and SCZ. Within groups, we generally observed high inter-individual variability of e-field intensities at a higher percentile of voxels. Conclusion MRI-based e-field modeling revealed significant differences in e-field strengths between clinical and non-clinical populations in addition to a general inter-individual variability. These findings support the notion that dose–response relationships for tDCS cannot be simply transferred from healthy to clinical cohorts and need to be individually established for clinical groups. In this respect, MRI-based e-field modeling may serve as a proxy for individualized dosing.
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Affiliation(s)
- Yuki Mizutani-Tiebel
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; NeuroImaging Core Unit Munich (NICUM), Munich, Germany.
| | - Shun Takahashi
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan; Clinical Research and Education Center, Asakayama General Hospital, Sakai, Japan; Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan; Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Temmuz Karali
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; Department of Radiology, University Hospital LMU, Munich, Germany
| | - Eva Mezger
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Lucia Bulubas
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Irina Papazova
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; Department of Psychiatry and Psychotherapy, University of Augsburg, Germany
| | - Esther Dechantsreiter
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | | | - Boris Papazov
- NeuroImaging Core Unit Munich (NICUM), Munich, Germany; Department of Radiology, University Hospital LMU, Munich, Germany
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; NeuroImaging Core Unit Munich (NICUM), Munich, Germany; Department of Radiology, University Hospital LMU, Munich, Germany; Munich Center for Neurosciences (MCN) - Brain & Mind, 82152 Planegg-Martinsried, Germany.
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Franca T, Andrea C, Arianna P, Teresa L, Eugenia G, Massimo B, Luca P, Silvana Z, Alessandro G, Domenico L, Patrizio P, Massimiliano M, Maddalena FM. Home treatment against fatigue in multiple sclerosis by a personalized, bilateral whole-body somatosensory cortex stimulation. Mult Scler Relat Disord 2022; 63:103813. [DOI: 10.1016/j.msard.2022.103813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/08/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
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Jones KT, Smith CC, Gazzaley A, Zanto TP. Research outside the laboratory: Longitudinal at-home neurostimulation. Behav Brain Res 2022; 428:113894. [DOI: 10.1016/j.bbr.2022.113894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/14/2022] [Accepted: 04/11/2022] [Indexed: 11/02/2022]
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Cappon D, den Boer T, Jordan C, Yu W, Lo A, LaGanke N, Biagi MC, Skorupinski P, Ruffini G, Morales O, Metzger E, Manor B, Pascual-Leone A. Safety and Feasibility of Tele-Supervised Home-Based Transcranial Direct Current Stimulation for Major Depressive Disorder. Front Aging Neurosci 2022; 13:765370. [PMID: 35185515 PMCID: PMC8849231 DOI: 10.3389/fnagi.2021.765370] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/08/2021] [Indexed: 12/23/2022] Open
Abstract
Major depressive disorder (MDD) is a worldwide cause of disability in older age, especially during the covid pandemic. Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that has shown encouraging efficacy for treatment of depression. Here, we investigate the feasibility of an innovative protocol where tDCS is administered within the homes of older adults with MDD (patient participants) with the help of a study companion (i.e. caregiver). We further analyze the feasibility of a remotely-hosted training program that provides the knowledge and skills to administer tDCS at home, without requiring them to visit the lab. We also employed a newly developed multi-channel tDCS system with real-time monitoring designed to guarantee the safety and efficacy of home-based tDCS. Patient participants underwent a total of 37 home-based tDCS sessions distributed over 12 weeks. The protocol consisted of three phases each lasting four weeks: an acute phase, containing 28 home-based tDCS sessions, a taper phase containing nine home-based tDCS sessions, and a follow up phase, with no stimulation sessions. We found that the home-based, remotely-supervised, study companion administered, multi-channel tDCS protocol for older adults with MDD was feasible and safe. Further, the study introduces a novel training program for remote instruction of study companions in the administration of tDCS. Future research is required to determine the translatability of these findings to a larger sample.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT04799405?term=NCT04799405&draw=2&rank=1, identifier NCT04799405.
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Affiliation(s)
- Davide Cappon
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- *Correspondence: Davide Cappon,
| | - Tim den Boer
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | - Caleb Jordan
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | - Alexander Lo
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | - Nicole LaGanke
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | | | | | | | - Oscar Morales
- Department of Psychiatry Harvard Medical School, Boston, MA, United States
| | - Eran Metzger
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Department of Psychiatry Harvard Medical School, Boston, MA, United States
| | - Bradley Manor
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- Guttmann Brain Health Institute, Barcelona, Spain
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Mares T, Albrecht J, Buday J, Podgorna G, Le TH, Magyarova E, Poshor K, Halik J, Buna J, Capek V, Kostylkova L, Klasova J, Fabian V, Anders M. Long-term effect of transcranial direct current stimulation in the treatment of chronic tinnitus: A randomized, placebo-controlled trial. Front Psychiatry 2022; 13:969800. [PMID: 36311525 PMCID: PMC9606613 DOI: 10.3389/fpsyt.2022.969800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Tinnitus is an intrusive and chronic illness affecting a significant portion of the population, decreasing affected individuals' quality of life and socioeconomic functioning. Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulatory method utilizing weak electrical currents to elicit short and long-term central nervous system changes. Several studies have proven its effect on tinnitus. We aimed to broaden the knowledge and provide data on the effect and its retention. METHODS In the randomized, double-blinded, sham-controlled trial, 39 patients (active n = 19, sham n = 20) underwent bifrontal tDCS (anode over right dorsolateral prefrontal cortex (DLPFC), cathode left DLPFC, current of 1.5 mA, 20 min, 6 sessions in 2 weeks). Tinnitus Functional Index (TFI), Iowa Tinnitus Handicap Questionnaire (ITHQ), Beck Anxiety Inventory (BAI), Zung Self-Rating Depression Scale (SDS), and WHO-Quality of Life-BREF were employed in 4 evaluation points, including the follow-ups of 6 weeks and 6 months. RESULTS We reached a delayed, significant long-term improvement (p < 0.05) in auditory difficulties associated with tinnitus and noticed it even after 6 months compared to placebo. We also reached a short-term, negative effect in the psychological domain of WHO-Quality of Life-BREF (p < 0.05). Not all subdomains of TFI and ITHQ reached statistical significance during the data analysis, even though specific positive trends were noticed. CONCLUSION We proved partial, positive, long-term effects of tDCS on tinnitus and short-term, negative, transient effect on a specific aspect of the general quality of life. We expanded upon the results of previous trials and provided data concerning the longevity and the precise effect of multiple sessions, bifrontal DLPFC tDCS. Our sample size (n = 39) was limited, which might have contributed to the lesser statistical power of the analyzed items. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT05437185].
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Affiliation(s)
- Tadeas Mares
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Jakub Albrecht
- Department of Psychiatry, Krajska zdravotni a.s. - Most Hospital, Most, Czechia
| | - Jozef Buday
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Gabriela Podgorna
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Thai Hong Le
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Eva Magyarova
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Katerina Poshor
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jakub Halik
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jan Buna
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Vaclav Capek
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Lenka Kostylkova
- National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Johana Klasova
- Department of Internal Medicine, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czechia
| | - Vratislav Fabian
- Department of Physics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Martin Anders
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
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Ikeda T, Nishida K, Yoshimura M, Ishii R, Tsukuda B, Bunai T, Ouchi Y, Kikuchi M. Toward the Development of tES- Based Telemedicine System: Insights From the Digital Transformation and Neurophysiological Evidence. Front Psychiatry 2022; 13:782144. [PMID: 35898624 PMCID: PMC9309473 DOI: 10.3389/fpsyt.2022.782144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Takashi Ikeda
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan.,United Graduate School of Child Development, Osaka University, Osaka, Japan
| | - Keiichiro Nishida
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Masafumi Yoshimura
- Department of Occupational Therapy, Faculty of Rehabilitation Kansai Medical University, Osaka, Japan.,Department of Neuropsychiatry, Kansai Medical University Medical Center, Osaka, Japan
| | - Ryouhei Ishii
- Occupational Therapy Major, Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan
| | - Banri Tsukuda
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Tomoyasu Bunai
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuomi Ouchi
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mitsuru Kikuchi
- United Graduate School of Child Development, Osaka University, Osaka, Japan.,Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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Cho H, Razza LB, Borrione L, Bikson M, Charvet L, Dennis-Tiwary TA, Brunoni AR, Sudbrack-Oliveira P. Transcranial Electrical Stimulation for Psychiatric Disorders in Adults: A Primer. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:19-31. [PMID: 35746931 PMCID: PMC9063596 DOI: 10.1176/appi.focus.20210020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- Hyein Cho
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Lais B Razza
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Lucas Borrione
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Marom Bikson
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Leigh Charvet
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Tracy A Dennis-Tiwary
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Andre R Brunoni
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Pedro Sudbrack-Oliveira
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
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Sobral M, Guiomar R, Martins V, Ganho-Ávila A. Home-based transcranial direct current stimulation in dual active treatments for symptoms of depression and anxiety: A case series. Front Psychiatry 2022; 13:947435. [PMID: 36276322 PMCID: PMC9583668 DOI: 10.3389/fpsyt.2022.947435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/22/2022] [Indexed: 11/21/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a potential treatment strategy across some psychiatric conditions. However, there is high heterogeneity in tDCS efficacy as a stand-alone treatment. To increase its therapeutic potential, researchers have begun to explore the efficacy of combining tDCS with psychological and pharmacological interventions. The current case series details the effect of 6-10 weeks of self-administered tDCS paired with a behavioral therapy smartphone app (Flow™), on depressive and anxiety symptoms, in seven patients (26-51 years old; four female) presenting distinctive psychiatric disorders (major depression, dysthymia, illness anxiety disorder, obsessive-compulsive disorder, and anxiety disorders). tDCS protocol consisted of an acute phase of daily 30 min sessions, across 10 workdays (2 weeks Monday-to-Friday; Protocol 1) or 15 workdays (3 weeks Monday-to-Friday; Protocol 2). A maintenance phase followed, with twice-weekly sessions for 4 or 3 weeks, corresponding to 18 or 21 sessions in total (Protocol 1 or 2, respectively). The Flow tDCS device uses a 2 mA current intensity, targeting the bilateral dorsolateral prefrontal cortex. The Flow app offers virtually guided behavioral therapy courses to be completed during stimulation. We assessed depressive symptoms using MADRS-S and BDI-II, anxious symptoms using STAI-Trait, acceptability using ACCEPT-tDCS, and side effects using the Adverse Effects Questionnaire, at baseline and week 6 of treatment. Six patients underwent simultaneous cognitive-behavioral psychotherapy and two were on antidepressants and benzodiazepines. According to the Reliable Change Index (RCI), for depressive symptoms, we found clinically reliable improvement in five patients using MADRS-S (out of seven; RCI: -1.45, 80% CI; RCI: -2.17 to -4.82, 95% CI; percentage change: 37.9-66.7%) and in four patients using BDI-II (out of five; RCI: -3.61 to -6.70, 95% CI; percentage change: 57.1-100%). For anxiety symptoms, clinically reliable improvement was observed in five patients (out of six; RCI: -1.79, 90% CI; RCI: -2.55 to -8.64, 95% CI; percentage change: 12.3-46.4%). Stimulation was well-tolerated and accepted, with mild tingling sensation and scalp discomfort being the most common side effects. This case series highlights the applicability, acceptability, and promising results when combining home-based tDCS with psychotherapy and pharmacotherapy to manage depression and anxiety symptoms in clinical practice.
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Affiliation(s)
- Mónica Sobral
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal.,Neuroncircuit-e.Stim Clínica de Saúde Mental, Coimbra, Portugal
| | - Raquel Guiomar
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Vera Martins
- Neuroncircuit-e.Stim Clínica de Saúde Mental, Coimbra, Portugal.,Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Ana Ganho-Ávila
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
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Cha YH, Riley J, Gleghorn D, Doudican B. Remotely Monitored Home-Based Neuromodulation With Transcranial Alternating Current Stimulation (tACS) for Mal de Débarquement Syndrome. Front Neurol 2021; 12:755645. [PMID: 34956048 PMCID: PMC8695966 DOI: 10.3389/fneur.2021.755645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/14/2021] [Indexed: 01/16/2023] Open
Abstract
Objective: To determine whether remotely-monitored transcranial alternating current stimulation (tACS) may be a viable and safe treatment option for Mal de Débarquement Syndrome (MdDS). Background: Mal de Débarquement Syndrome is a neurotological disorder characterized by persistent oscillating vertigo that is triggered by entrainment to passive oscillatory motion such as occurs during water-based travel. Treatment options for MdDS are limited, variably effective, and can be undone by further travel. Design and Methods: This was a remotely-monitored open-label optional extension phase of a double-blind randomized onsite study of tACS for medically refractory MdDS. The primary goal was to determine safety, feasibility, and blinded participant feedback. The secondary goal was to determine efficacy. Thirteen participants (all women), aged 22–67 years, experiencing a duration of illness of 11–72 months, were a subset of 24 individuals who participated in an on-site study of tACS. They had either not responded to the on-site protocol or had relapsed after travel home. Treatment accessories and a tablet controlled tACS stimulator (Pulvinar XCSITE-100) were mailed to participants. Three teaching sessions were performed via webcam followed by on-going remote monitoring of treatment logs and participants' reports through a daily on-line diary and weekly questionnaires. Treatment continued until an effective protocol was administered for 4 weeks and then tapered over 4 weeks. Participants completed a blinded feedback survey and a debriefing interview at the completion of the entire study. Results: Treatment duration ranged from 4 to 31 weeks followed by a 4-week taper accounting for 578 verified sessions. Of the 13 total participants, seven agreed or agreed strongly in the blinded survey that tACS treatment was beneficial; 2) Twelve were comfortable utilizing tACS on their own; 3) Eleven preferred stimulation above their individual alpha frequency; 4) Side effects were generally mild and typical of tACS. In the debriefing interview completed 2–9 months after the last stimulation, five participants reported doing “great,” with no to minimal symptoms, four reported doing “good,” with moderate symptoms, and four reported no change compared to pre-study baseline. Conclusion: Remotely-monitored tACS may be a safe treatment option for MdDS with the potential for lasting outcomes, increased accessibility, and reduction in travel-related treatment reversal.
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Affiliation(s)
- Yoon-Hee Cha
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States.,Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Jeff Riley
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Diamond Gleghorn
- Laureate Institute for Brain Research, Tulsa, OK, United States.,Physician Assistant Studies Graduate Program, Missouri State University, Springfield, MO, United States
| | - Benjamin Doudican
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States.,Laureate Institute for Brain Research, Tulsa, OK, United States.,College of Osteopathic Medicine, Oklahoma State University, Tulsa, OK, United States
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Wu Q, Wang X, Wang Y, Long YJ, Zhao JP, Wu RR. Developments in Biological Mechanisms and Treatments for Negative Symptoms and Cognitive Dysfunction of Schizophrenia. Neurosci Bull 2021; 37:1609-1624. [PMID: 34227057 PMCID: PMC8566616 DOI: 10.1007/s12264-021-00740-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/05/2021] [Indexed: 12/12/2022] Open
Abstract
The causal mechanisms and treatment for the negative symptoms and cognitive dysfunction in schizophrenia are the main issues attracting the attention of psychiatrists over the last decade. The first part of this review summarizes the pathogenesis of schizophrenia, especially the negative symptoms and cognitive dysfunction from the perspectives of genetics and epigenetics. The second part describes the novel medications and several advanced physical therapies (e.g., transcranial magnetic stimulation and transcranial direct current stimulation) for the negative symptoms and cognitive dysfunction that will optimize the therapeutic strategy for patients with schizophrenia in future.
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Affiliation(s)
- Qiongqiong Wu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Xiaoyi Wang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Ying Wang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Yu-Jun Long
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Jing-Ping Zhao
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
| | - Ren-Rong Wu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
- Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031, China.
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Dyke K, Jackson G, Jackson S. Non-invasive brain stimulation as therapy: systematic review and recommendations with a focus on the treatment of Tourette syndrome. Exp Brain Res 2021; 240:341-363. [PMID: 34643763 PMCID: PMC8858270 DOI: 10.1007/s00221-021-06229-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/18/2021] [Indexed: 01/06/2023]
Abstract
Tourette syndrome (TS) is a neurodevelopmental condition characterised by tics, which are stereotyped movements and/or vocalisations. Tics often cause difficulties in daily life and many with TS express a desire to reduce and/or gain control over them. No singular effective treatment exists for TS, and while pharmacological and behavioural interventions can be effective, the results are variable, and issues relating to access, availability and side effects can be barriers to treatment. Consequently, over the past decade, there has been increasing interest into the potential benefits of non-invasive brain stimulation (NIBS) approaches. This systematic review highlights work exploring NIBS as a potential treatment for TS. On balance, the results tentatively suggest that multiple sessions of stimulation applied over the supplementary motor area (SMA) may help to reduce tics. However, a number of methodological and theoretical issues limit the strength of this conclusion, with the most problematic being the lack of large-scale sham-controlled studies. In this review, methodological and theoretical issues are discussed, unanswered questions highlighted and suggestions for future work put forward.
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Affiliation(s)
- Katherine Dyke
- School of Psychology, University of Nottingham, Nottingham, UK.
| | - Georgina Jackson
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK.,School of Medicine, The University of Nottingham, Nottingham, UK
| | - Stephen Jackson
- School of Psychology, University of Nottingham, Nottingham, UK.,Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
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Herrera-Melendez AL, Bajbouj M, Aust S. Application of Transcranial Direct Current Stimulation in Psychiatry. Neuropsychobiology 2021; 79:372-383. [PMID: 31340213 DOI: 10.1159/000501227] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a neuromodulation technique, which noninvasively alters cortical excitability via weak polarizing currents between two electrodes placed on the scalp. Since it is comparably easy to handle, cheap to use and relatively well tolerated, tDCS has gained increasing interest in recent years. Based on well-known behavioral effects, a number of clinical studies have been performed in populations including patients with major depressive disorder followed by schizophrenia and substance use disorders, in sum with heterogeneous results with respect to efficacy. Nevertheless, the potential of tDCS must not be underestimated since it could be further improved by systematically investigating the various stimulation parameters to eventually increase clinical efficacy. The present article briefly explains the underlying physiology of tDCS, summarizes typical stimulation protocols and then reviews clinical efficacy for various psychiatric disorders as well as prevalent adverse effects. Future developments include combined and more complex interactions of tDCS with pharmacological or psychotherapeutic interventions. In particular, using computational models to individualize stimulation protocols, considering state dependency and applying closed-loop technologies will pave the way for tDCS-based personalized interventions as well as the development of home treatment settings promoting the role of tDCS as an effective treatment option for patients with mental health problems.
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Affiliation(s)
- Ana-Lucia Herrera-Melendez
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany,
| | - Malek Bajbouj
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sabine Aust
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Razza LB, De Smet S, Moffa A, Sudbrack-Oliveira P, Vanderhasselt MA, Brunoni AR. Follow-up effects of transcranial direct current stimulation (tDCS) for the major depressive episode: A systematic review and meta-analysis. Psychiatry Res 2021; 302:114024. [PMID: 34058716 DOI: 10.1016/j.psychres.2021.114024] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/15/2021] [Indexed: 12/17/2022]
Abstract
Transcranial Direct Current Stimulation (tDCS) is an effective treatment during the acute phase of a major depressive episode (MDE), although the evidence for its follow-up efficacy is mixed. A systematic review and meta-analysis were performed. MEDLINE/PubMed, Scopus (EMBASE), Web of Science, Cochrane Library and additional sources were searched from inception to April 29, 2021. Studies that followed up adults treated with tDCS during an MDE - using (interventional) and/or not using (observational) tDCS in the follow-up period were included. The primary outcome was the Hedges' g for the follow-up depression scores. Small study effects and sources of heterogeneity were explored. 427 studies were retrieved and 11 trials (13 datasets, n = 311) were included, most presenting moderate bias. Results showed a follow-up depression improvement (k = 13, g = -0.81, 95% confidence interval [CI]: -1.28; -0.34, I² = 84.0%), which was probably driven by the interventional studies (k = 7, g= -1.12, 95% CI: -1.84; -0.40, I² = 87.1%). No predictor of response was associated with the outcome. No risk of publication bias was found. Significant between-study heterogeneity may have influenced the overall results. Our findings suggest that tDCS produces effects beyond the intervention period during MDEs. Maintenance sessions are advised in future research.
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Affiliation(s)
- Laís B Razza
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Clinical Hospital, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Stefanie De Smet
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Ghent, Belgium
| | - Adriano Moffa
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Pedro Sudbrack-Oliveira
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Clinical Hospital, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Ghent, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - André R Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Clinical Hospital, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Departamento de Medicina Interna, Faculdade de Medicina Universidade de São Paulo e Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, 05508-000, São Paulo, Brazil
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Pacheco F, Guiomar R, Brunoni AR, Buhagiar R, Evagorou O, Roca-Lecumberri A, Poleszczyk A, Lambregtse-van den Berg M, Caparros-Gonzalez RA, Fonseca A, Osório A, Soliman M, Ganho-Ávila A. Efficacy of non-invasive brain stimulation in decreasing depression symptoms during the peripartum period: A systematic review. J Psychiatr Res 2021; 140:443-460. [PMID: 34147932 DOI: 10.1016/j.jpsychires.2021.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/04/2021] [Accepted: 06/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Non-invasive brain stimulation (NIBS) techniques have been suggested as alternative treatments to decrease depression symptoms during the perinatal period. These include brain stimulation techniques that do not require surgery and that are nonpharmacological and non-psychotherapeutic. NIBS with evidence of antidepressant effects include repetitive transcranial magnetic stimulation (rTMS), transcranial electric stimulation (TES) and electroconvulsive therapy (ECT). OBJECTIVES This systematic review aims to summarize evidence on NIBS efficacy, safety and acceptability in treating peripartum depression (PPD). METHODS We included randomized, non-randomized and case reports, that used NIBS during pregnancy and the postpartum. The reduction of depressive symptoms and neonatal safety were the primary and co-primary outcomes, respectively. RESULTS rTMS shows promising results for the treatment of PPD, with clinically significant decreases in depressive symptoms between baseline and end of treatment and overall good acceptability. Although the safety profile for rTMS is adequate in the postpartum, caution is warranted during pregnancy. In TES, evidence on efficacy derives mostly from single-arm studies, compromising the encouraging findings. Further investigation is necessary concerning ECT, as clinical practice relies on clinical experience and is only described in low-quality case-reports. LIMITATIONS The reduced number of controlled studies, the lack of complete datasets and the serious/high risk of bias of the reports warrant cautious interpretations. CONCLUSIONS AND IMPLICATIONS Existing evidence is limited across NIBS techniques; comparative studies are lacking, and standard stimulation parameters are yet to be established. Although rTMS benefits from the most robust research, future multicenter randomized clinical trials are needed to determine the position of each NIBS strategy within the pathways of care.
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Affiliation(s)
- Francisca Pacheco
- University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Raquel Guiomar
- Center for Research in Neuropsychology and Cognitive-Behavior Interventions, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Andre R Brunoni
- Department of Internal Medicine and Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Olympia Evagorou
- University General Hospital of Alexandroupolis, Department of Psychiatry, Greece
| | - Alba Roca-Lecumberri
- Perinatal Mental Health Unit, Psychiatry and Clinical Psychology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Mijke Lambregtse-van den Berg
- Departments of Psychiatry and Child & Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Ana Fonseca
- University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal; Center for Research in Neuropsychology and Cognitive-Behavior Interventions, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Ana Osório
- Graduate Program on Developmental Disorders, Center for Biological and Health Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Mahmoud Soliman
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ana Ganho-Ávila
- Center for Research in Neuropsychology and Cognitive-Behavior Interventions, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
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Kurzeck AK, Dechantsreiter E, Wilkening A, Kumpf U, Nenov-Matt T, Padberg F, Palm U. Transcranial Direct Current Stimulation (tDCS) for Depression during Pregnancy: Results from an Open-Label Pilot Study. Brain Sci 2021; 11:brainsci11070947. [PMID: 34356180 PMCID: PMC8304475 DOI: 10.3390/brainsci11070947] [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: 04/27/2021] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Depression is the most common morbidity during pregnancy. Available first-line therapy options are limited and depressive disorders in pregnant women are often untreated, leading to negative effects on maternal and fetal health. OBJECTIVES The aim of this open-label pilot study is to extend evidence on the use of transcranial direct current stimulation (tDCS) as a treatment of antenatal depression and to point out options for the use of tDCS in this population. METHODS Six drug-free female patients with major depressive disorder during pregnancy (later than 10th gestational week) were included in this pilot study. Patients were treated with twice-daily tDCS (2 mA, 30 min, anode: F3, cathode: F4) over ten days during inpatient stay (Phase 1) and with once-daily tDCS over 10 days during an optional outpatient stay (Phase 2). Clinical (HAMD-21, BDI) and neuropsychological ratings (Trail Making Test A/B) were performed at baseline, after two and four weeks as well as an obstetric examination. RESULTS Six right-handed females (23-43 years, 12-33. gestational week) completed Phase 1; four patients additionally joined in Phase 2. tDCS was well tolerated and no adverse effects occurred. Clinical ratings showed an improvement of mean baseline HAMD-21 from 22.50 ± 7.56 to 13.67 ± 3.93 after week 2, and to 8.75 ± 4.99 after week 4. The mean baseline BDI was 26.00 ± 13.90 and declined to 11.17 ± 5.46 after week 2, and to 9.25 ± 3.30 after week 4. CONCLUSIONS Statistically significant changes in HAMD-21 and BDI were observed after Phase 1. One patient achieved remission in terms of HAMD in Phase 1. Although this small-scale study lacks sham control, it shows clinical improvement and absence of adverse events in this critical population.
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Affiliation(s)
- Anna Katharina Kurzeck
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
| | - Esther Dechantsreiter
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
| | - Anja Wilkening
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
| | - Ulrike Kumpf
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
| | - Tabea Nenov-Matt
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
| | - Frank Padberg
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
| | - Ulrich Palm
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
- Medical Park Chiemseeblick, Hospital for Psychosomatics, Rasthausstr. 25, 83233 Bernau-Felden, Germany
- Correspondence:
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Rangarajan SK, Suhas S, Reddy MSS, Sreeraj VS, Sivakumar PT, Venkatasubramanian G. Domiciliary tDCS in Geriatric Psychiatric Disorders: Opportunities and Challenges. Indian J Psychol Med 2021; 43:351-356. [PMID: 34385730 PMCID: PMC8327869 DOI: 10.1177/02537176211003666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Subhashini K Rangarajan
- Dept. of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mukku Shiva Shanker Reddy
- Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vanteemar S Sreeraj
- WISER Neuromodulation Programme, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Palanimuthu Thangaraju Sivakumar
- Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ganesan Venkatasubramanian
- WISER Neuromodulation Programme, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Smits FM, de Kort GJ, Geuze E. Acceptability of tDCS in treating stress-related mental health disorders: a mixed methods study among military patients and caregivers. BMC Psychiatry 2021; 21:97. [PMID: 33588798 PMCID: PMC7883955 DOI: 10.1186/s12888-021-03086-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/01/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Noninvasive brain stimulation techniques like transcranial direct current stimulation (tDCS) offer potential new approaches to treat stress-related mental health disorders. While the acceptability of tDCS as a treatment tool plays a crucial role in its development and implementation, little is known about tDCS acceptability for users in mental healthcare, especially in the context of stress-related disorders. METHODS Using a mixed-methods approach, we investigated tDCS acceptability among 102 active duty and post-active military patients with stress-related symptoms (posttraumatic stress disorder, anxiety and impulsive aggression) who participated in a 5-session tDCS intervention. Quantitative dropout and adverse effects data was collected for all patients involved in the sham-controlled tDCS intervention. We additionally explored perspectives on the acceptability of tDCS treatment via a theory-based semi-structured interview. A subgroup of patients as well as their caregivers were interviewed to include the views of both patients and mental healthcare professionals. RESULTS Quantitative outcomes showed minimal tDCS-related adverse effects (mild itching or burning sensations on the scalp) and high tDCS treatment adherence (dropout rate: 4% for active tDCS, 0% for sham). The qualitative outcomes showed predominantly positive attitudes towards tDCS interventions for stress-related disorders, but only as complementary to psychotherapy. Remarkably, despite the perception that sufficient explanation was provided, patients and caregivers stressed that tDCS treatment comprehension was limited and should improve. Also, the travel associated with frequent on-site tDCS sessions may produce a significant barrier to care for patients with stress-related disorders and active-duty military personnel. CONCLUSIONS Acceptability numbers and perspectives from military patients and caregivers suggest that tDCS is an acceptable complementary tool in the treatment of stress-related disorders. Critically, however, if tDCS is to be used beyond scientific studies, adequately educating users on tDCS working mechanisms is vital to further improve its acceptability. Also, the perceived potential barrier to care due to frequent travel may favor home-based tDCS solutions. TRIAL REGISTRATION The tDCS intervention was part of a sham-controlled trial registered on 05-18-2016 at the Netherlands Trial Register with ID NL5709 .
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Affiliation(s)
- Fenne M. Smits
- grid.462591.dBrain Research & Innovation Centre, Ministry of Defence, Lundlaan 1, 3584 EZ Utrecht, The Netherlands ,grid.7692.a0000000090126352Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Guido J. de Kort
- grid.462591.dBrain Research & Innovation Centre, Ministry of Defence, Lundlaan 1, 3584 EZ Utrecht, The Netherlands
| | - Elbert Geuze
- grid.462591.dBrain Research & Innovation Centre, Ministry of Defence, Lundlaan 1, 3584 EZ Utrecht, The Netherlands ,grid.7692.a0000000090126352Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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48
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Sprugnoli G, Golby AJ, Santarnecchi E. Newly discovered neuron-to-glioma communication: new noninvasive therapeutic opportunities on the horizon? Neurooncol Adv 2021; 3:vdab018. [PMID: 33738449 PMCID: PMC7954106 DOI: 10.1093/noajnl/vdab018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The newly discovered functional integration of glioma cells into brain networks in mouse models provides groundbreaking insight into glioma aggressiveness and resistance to treatments, also suggesting novel potential therapeutic avenues and targets. In the context of such neuron-to-glioma communication, noninvasive brain modulation techniques traditionally applied to modulate neuronal function in neurological and psychiatric diseases (eg, increase/decrease cortical excitability and plasticity) could now be tested in patients with brain tumors to suppress glioma’s activity and its pathological crosstalk with healthy brain tissue.
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Affiliation(s)
- Giulia Sprugnoli
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Radiology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.,Departments of Neurosurgery and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra J Golby
- Radiology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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49
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Haller N, Hasan A, Padberg F, Strube W, da Costa Lane Valiengo L, Brunoni AR, Brunelin J, Palm U. [Transcranial electrical brain stimulation methods for treatment of negative symptoms in schizophrenia]. DER NERVENARZT 2021; 93:41-50. [PMID: 33492411 PMCID: PMC8763819 DOI: 10.1007/s00115-021-01065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/24/2022]
Abstract
Über die letzten Jahre entwickelten sich Neuromodulationsverfahren zu einer dritten Säule neben Pharmakotherapie und Psychotherapie in der Behandlung psychischer Erkrankungen. Besonders in der Behandlung von Menschen mit einer Schizophrenie könnten Hirnstimulationsverfahren eine Alternative oder Ergänzung zu den etablierten Therapiestrategien darstellen. Die meist vorhandenen Positivsymptome können zumeist mit Antipsychotika adäquat behandelt werden. Gerade bei Patienten mit Schizophrenie besitzen jedoch Negativsymptome einen überdauernden Krankheitswert und beeinflussen den Verlauf durch globale Antriebsverarmung und beeinträchtigte Kognition im alltäglichen Leben negativ. Dieser Übersichtsartikel stellt eine Zusammenfassung über die verschiedenen nichtinvasiven Hirnstimulationsverfahren transkranielle Gleichstromstimulation (transcranial direct current stimulation, tDCS), Wechselstromstimulation (transcranial alternating current stimulation, tACS) sowie Rauschstromstimulation (transcranial random noise stimulation, tRNS) zur Behandlung der Negativsymptomatik bei Schizophrenie dar. Die neuen transkraniellen Hirnstimulationsverfahren könnten dabei helfen, gestörte neuronale Vernetzungen wieder herzustellen und die Konnektivität vor allem der dorsolateralen präfrontalen Anteile des Kortex zu verbessern. Einige Studien weisen auf eine Verbesserung der Negativsymptome durch Behandlung mit tDCS, tACS bzw. tRNS hin und könnten so neue Therapiemöglichkeiten in der Behandlung der Schizophrenie darstellen.
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Affiliation(s)
- Nikolas Haller
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Alkomiet Hasan
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland.,Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universität Augsburg, Medizinische Fakultät, BKH Augsburg, Augsburg, Deutschland
| | - Frank Padberg
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Wolfgang Strube
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universität Augsburg, Medizinische Fakultät, BKH Augsburg, Augsburg, Deutschland
| | - Leandro da Costa Lane Valiengo
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasilien
| | - Andre R Brunoni
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasilien
| | - Jerome Brunelin
- CH le Vinatier, INSERM U 1028, CNRS UMR 5292, PSYR2 Team, Centre de recherche en neuroscience de Lyon, Université de Lyon, Lyon, Frankreich
| | - Ulrich Palm
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland. .,Medical Park Chiemseeblick, Rasthausstr. 25, 83233, Bernau-Felden, Deutschland.
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50
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Baptista AF, Baltar A, Okano AH, Moreira A, Campos ACP, Fernandes AM, Brunoni AR, Badran BW, Tanaka C, de Andrade DC, da Silva Machado DG, Morya E, Trujillo E, Swami JK, Camprodon JA, Monte-Silva K, Sá KN, Nunes I, Goulardins JB, Bikson M, Sudbrack-Oliveira P, de Carvalho P, Duarte-Moreira RJ, Pagano RL, Shinjo SK, Zana Y. Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19. Front Neurol 2020; 11:573718. [PMID: 33324324 PMCID: PMC7724108 DOI: 10.3389/fneur.2020.573718] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19. Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders. Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders. Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway. Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.
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Affiliation(s)
- Abrahão Fontes Baptista
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Brazilian Institute of Neuroscience and Neurotechnology Centros de Pesquisa, Investigação e Difusão - Fundação de Amparo à Pesquisa do Estado de São Paulo (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, Brazil
- Laboratory of Medical Investigations 54 (LIM-54), São Paulo University, São Paulo, Brazil
| | - Adriana Baltar
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Specialized Neuromodulation Center—Neuromod, Recife, Brazil
| | - Alexandre Hideki Okano
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Brazilian Institute of Neuroscience and Neurotechnology Centros de Pesquisa, Investigação e Difusão - Fundação de Amparo à Pesquisa do Estado de São Paulo (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, Brazil
- Graduate Program in Physical Education, State University of Londrina, Londrina, Brazil
| | - Alexandre Moreira
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | - Ana Mércia Fernandes
- Centro de Dor, LIM-62, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - André Russowsky Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria, São Paulo, Brazil
- Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bashar W. Badran
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Clarice Tanaka
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Laboratory of Medical Investigations 54 (LIM-54), São Paulo University, São Paulo, Brazil
- Instituto Central, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Centro de Dor, LIM-62, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Edgard Morya
- Edmond and Lily Safra International Neuroscience Institute, Santos Dumont Institute, Macaiba, Brazil
| | - Eduardo Trujillo
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
| | - Jaiti K. Swami
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, United States
| | - Joan A. Camprodon
- Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Katia Monte-Silva
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Brazil
| | - Katia Nunes Sá
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Isadora Nunes
- Department of Physiotherapy, Pontifícia Universidade Católica de Minas Gerais, Betim, Brazil
| | - Juliana Barbosa Goulardins
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Laboratory of Medical Investigations 54 (LIM-54), São Paulo University, São Paulo, Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
- Universidade Cruzeiro do Sul (UNICSUL), São Paulo, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, United States
| | | | - Priscila de Carvalho
- Instituto Central, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafael Jardim Duarte-Moreira
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
| | | | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Yossi Zana
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
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