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Despoti A, Megari K, Tsiakiri A, Toumaian M, Koutzmpi V, Liozidou A, Tsapanou A. Effectiveness of remote neuropsychological interventions: A systematic review. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-9. [PMID: 39067003 DOI: 10.1080/23279095.2024.2382814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Remote healthcare services is an upgrowing dynamic field that has been used to reduce potential disease spread and prevent overloading of the healthcare system during COVID-19 pandemic. The need for online interventions during the pandemic required immediate response with sometimes inadequate preparation. The aim of the present study is to investigate the effectiveness of remote healthcare services in the field of neuropsychological interventions. METHODS A systematic literature search was conducted in the electronic databases of PubMed, PsychINFO and Google Scholar. The main search terms were "remote neuropsychological intervention or training." The included articles were RCT studies published in English, examining the effectiveness of remote healthcare services in neuropsychological interventions for adults with neurological disease diagnoses. Studies involving psychiatric disorders were excluded. Two reviewers assessed the quality of the studies and risk of bias using the PEDro Scale. RESULTS A total of 10 studies with 2.221 participants were included. All studies concluded that remote healthcare intervention programs can be feasible, safe and effective in the rehabilitation process of neurological diseases. DISCUSSION The present review demonstrated that the domains of neuropsychology have opportunities to forge ahead beyond traditional settings and have the ability to adapt to constantly changing environmental conditions with a view to providing patient care. Health policy plans should therefore be reformulated to include these needs in accordance with the social and cultural context of implementation.
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Affiliation(s)
- Akyllina Despoti
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
- Hellenic Neuropsychological Society, Athens, Greece
| | - Kalliopi Megari
- Hellenic Neuropsychological Society, Athens, Greece
- CITY College, University of York Europe Campus, Thessaloniki, Greece
| | - Anna Tsiakiri
- Hellenic Neuropsychological Society, Athens, Greece
- Department of Neurology, Medical School, Democritus University of Thrace, Alexandroupoli, Greece
| | - Maida Toumaian
- Hellenic Neuropsychological Society, Athens, Greece
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "Costas Stefanis,"Athens, Greece
| | - Vasiliki Koutzmpi
- Hellenic Neuropsychological Society, Athens, Greece
- Athens Alzheimer's Association, Athens, Greece
| | - Athanasia Liozidou
- Hellenic Neuropsychological Society, Athens, Greece
- Laboratory of Cognitive Neuroscience and Clinical Neuropsychology, Psychology Department, Scientific College of Greece
- Laboratory of Clinical Neuropsychology, Eginiteion Hospital, Neurology Department, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Angeliki Tsapanou
- Hellenic Neuropsychological Society, Athens, Greece
- Athens Alzheimer's Association, Athens, Greece
- Cognitive Neuroscience Division, Columbia University Irving Medical Center, New York, NY, USA
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Muccio M, Pilloni G, Walton Masters L, He P, Krupp L, Datta A, Bikson M, Charvet L, Ge Y. Simultaneous and cumulative effects of tDCS on cerebral metabolic rate of oxygen in multiple sclerosis. Front Hum Neurosci 2024; 18:1418647. [PMID: 39081842 PMCID: PMC11286420 DOI: 10.3389/fnhum.2024.1418647] [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: 04/16/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique with simultaneous (during stimulation) and cumulative effects (after repeated sessions) on blood flow and neuronal metabolism. These effects remain mostly unclear especially in multiple sclerosis (MS). This work aims to elucidate brain metabolic and hemodynamic underpinnings of tDCS and its potential therapeutic impact in MS patients using quantitative tDCS-MRI. Methods MS participants (n = 20; age = 45.4 ± 12.3 years, 7 males) underwent 3 T MRI scans before and after 20 daily sessions of dorsolateral prefrontal cortex (DLFPC) tDCS (2.0 mA, left anodal) paired with adaptive cognitive training (aCT). During both visits, imaging measurements of cerebral blood flow (CBF), cerebral venous blood oxygenation (Yv) and calculated cerebral metabolic rate of oxygen (CMRO2) were obtained at pre-tDCS, during-tDCS and post-tDCS. Results At baseline, significant increase from pre- to during-tDCS was observed in CMRO2 (7.6%; p = 0.002), CBF (11.0%; p < 0.0001) and Yv (1.9%; p = 0.006). At follow up, we observed an increase in pre-tDCS CMRO2 (140.59 ± 13.83 μmol/100 g/min) compared to baseline pre-tDCS levels (128.30 ± 14.00 μmol/100 g/min; p = 0.006). Sustained elevations in CMRO2 and CBF into post-tDCS were also observed (tDCS lingering effects). Cumulative tDCS effects were observed in the form of sustained elevations in CMRO2 and CBF in pre-tDCS follow up, reaching the magnitudes measured at baseline during-tDCS. Discussion TDCS induces an acute surge in metabolic activity persisting immediately after the stimulation is removed. Moreover, treatment composed of repeated tDCS-aCT paired sessions contributes to establishing long-lasting increases in neuronal activity.
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Affiliation(s)
- Marco Muccio
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States
| | - Giuseppina Pilloni
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | | | - Peidong He
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States
| | - Lauren Krupp
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Abhishek Datta
- Research and Development, Soterix Medical, Inc., Woodbridge, NJ, United States
| | - Marom Bikson
- Department of Biomedical Engineering, City College of New York, New York, NY, United States
| | - Leigh Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Yulin Ge
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States
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Baldasso BD, Raza SZ, Islam SS, Burry IB, Newell CJ, Hillier SR, Ploughman M. Disrupted hemodynamic response within dorsolateral prefrontal cortex during cognitive tasks among people with multiple sclerosis-related fatigue. PLoS One 2024; 19:e0303211. [PMID: 38837991 DOI: 10.1371/journal.pone.0303211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/21/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Mental fatigue is an early and enduring symptom in persons with autoimmune disease particularly multiple sclerosis (MS). Neuromodulation has emerged as a potential treatment although optimal cortical targets have yet to be determined. We aimed to examine cortical hemodynamic responses within bilateral dorsolateral prefrontal cortex (dlPFC) and frontopolar areas during single and dual cognitive tasks in persons with MS-related fatigue compared to matched controls. METHODS We recruited persons (15 MS and 12 age- and sex-matched controls) who did not have physical or cognitive impairment and were free from depressive symptoms. Functional near infrared spectroscopy (fNIRS) registered hemodynamic responses during the tasks. We calculated oxyhemoglobin peak, time-to-peak, coherence between channels (a potential marker of neurovascular coupling) and functional connectivity (z-score). RESULTS In MS, dlPFC demonstrated disrupted hemodynamic coherence during both single and dual tasks, as evidenced by non-significant and negative correlations between fNIRS channels. In MS, reduced coherence occurred in left dorsolateral PFC during the single task but occurred bilaterally as the task became more challenging. Functional connectivity was lower during dual compared to single tasks in the right dorsolateral PFC in both groups. Lower z-score was related to greater feelings of fatigue. Peak and time-to-peak hemodynamic response did not differ between groups or tasks. CONCLUSIONS Hemodynamic responses were inconsistent and disrupted in people with MS experiencing mental fatigue, which worsened as the task became more challenging. Our findings point to dlPFC, but not frontopolar areas, as a potential target for neuromodulation to treat cognitive fatigue.
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Affiliation(s)
- Bruna D Baldasso
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Syed Z Raza
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Sadman S Islam
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Computer Science, Faculty of Science, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Isabella B Burry
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Caitlin J Newell
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Sydney R Hillier
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michelle Ploughman
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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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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Akbari NJ, Tahan N, Naimi SS, Baghban AA, Moghadam NB, Zoghi M. Comparing the effects of cerebellar and prefrontal anodal transcranial direct current stimulation concurrent with postural training on balance and fatigue in patients with multiple sclerosis: a double-blind, randomized, sham-controlled trial. Exp Brain Res 2024; 242:1087-1100. [PMID: 38483566 DOI: 10.1007/s00221-024-06816-9] [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: 11/23/2023] [Accepted: 02/26/2024] [Indexed: 06/09/2024]
Abstract
Fatigue and balance disorders are common challenges experienced by Multiple Sclerosis (MS) individuals. The purpose of this study was to compare the concurrent effects of cerebellar and prefrontal anodal trans-cranial direct current stimulation (a-tDCS) with postural training on balance and fatigue in MS patients. 51 patients were evaluated to randomly allocation to a-tDCS over cerebellum, a-tDCS over dorsolateral prefrontal cortex (DLPFC) and sham group. 46 individuals (n = 16 in experimental groups and n = 14 in control group) followed treatment. All the groups received 10 sessions of postural training. The experimental groups underwent a-tDCS with a current of 1.5 mA for a period of 20 min. While, in the sham group, tDCS was only activated for 30 s and then turned off. The treatment included 10 sessions for four weeks. Before and after intervention, fatigue and balance were assessed using Fatigue Severity Scale (FSS), Timed Up and Go (TUG) test and Berg Balance Score (BBS), respectively. There was found a significant reduction in fatigue in the group receiving a-tDCS over the prefrontal cortex with postural training compared to the other two groups (P < 0.001). Additionally, a significant improvement was found in balance in the group receiving a-tDCS over the cerebellum concurrent with postural training in comparison to the other two groups (P < 0.001). Besides, in the sham group, the significant results were not reported in the variables. (P > 0.001). The results demonstrated that a-tDCS enhances the effects of postural training on balance and fatigue in MS patients.
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Affiliation(s)
- Narges Jahantigh Akbari
- Student Research Committee, Department of Physical Therapy, School of Rehabilitation, PhD Candidate of Physiotherapy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nahid Tahan
- Department of Physical Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Damavand street, Emam Hossein square, Tehran, 1616913111, Iran.
| | - Sedigheh Sadat Naimi
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nahid Beladi Moghadam
- Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Maryam Zoghi
- Discipline of Physiotherapy, Institute of Health and Wellbeing, Federation University Australia, Ballarat, Australia
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Sari F, Oskay D, Tufan A. Effects of a telerehabilitation-based exercise program in patients with systemic sclerosis. Z Rheumatol 2024; 83:167-174. [PMID: 37097308 PMCID: PMC10127957 DOI: 10.1007/s00393-023-01346-1] [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] [Accepted: 02/21/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND This study aimed to evaluate the effect of telerehabilitation-based exercise programs in systemic sclerosis (SSc) patients. METHODS Forty-six SSc patients were randomly separated into two groups as telerehabilitation and control. Videos comprising clinical Pilates-based exercises were designed and uploaded to YouTube™ for the telerehabilitation group by physiotherapists. A video interview was conducted with the SSc patients once a week and an exercise program was performed twice daily for 8 weeks in the telerehabilitation group. The same exercise programs were printed on paper brochures and patients were instructed on their application in the form of a home exercise program to be continued for 8 weeks in the control group. Pain, fatigue, quality of life, sleep, physical activity, anxiety, and depression were assessed in all patients at the beginning and end of the study. RESULTS The clinical and demographic characteristics were similar in both groups (p > 0.05). Fatigue, pain, anxiety, and depression decreased in both groups, while quality of life and sleep quality increased after the exercise program (p < 0.05). However, the improvements in the telerehabilitation group were statistically more significant than in the control group for all studied parameters (p < 0.05). CONCLUSION The results of our study demonstrate the superior efficacy of telerehabilitation-based treatment programs over home exercise programs, hence, we suggest widespread use of this innovative treatment program in SSc patients.
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Affiliation(s)
- Fulden Sari
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bingol University, 12000, Bingol, Turkey.
| | - Deran Oskay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Abdurrahman Tufan
- Inflamatuar Disease Section, National Human Genome Research Institute, Rockville Pike, USA
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Pagliari C, Di Tella S, Jonsdottir J, Mendozzi L, Rovaris M, De Icco R, Milanesi T, Federico S, Agostini M, Goffredo M, Pellicciari L, Franceschini M, Cimino V, Bramanti P, Baglio F. Effects of home-based virtual reality telerehabilitation system in people with multiple sclerosis: A randomized controlled trial. J Telemed Telecare 2024; 30:344-355. [PMID: 34851211 DOI: 10.1177/1357633x211054839] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Multiple sclerosis is an inflammatory and neurodegenerative disorder of the central nervous system that can lead to severe motor disability. The aim of this study was to verify the health care effects of an integrated telerehabilitation approach involving dual-domains (motor and cognitive) in people with multiple sclerosis using a virtual reality rehabilitation system compared to a home-based conventional rehabilitative intervention usual care for patient-relevant outcomes (motor, cognitive and participation). METHODS This multicentre interventional, randomized controlled trial included 70 participants with multiple sclerosis, 35 in the telerehabilitation group (30 sessions of home-based virtual reality rehabilitation system training, five sessions for week each lasting 45 min) and 35 in the usual care group (30 sessions of conventional treatment, five sessions for week). Participants completed the assessment of motor, cognitive and participation outcomes at baseline and after 6 weeks of treatment. RESULTS In total, 63.3% of the telerehabilitation group exhibited improvement in the physical domain of the quality of life (p = 0.045). The telerehabilitation group showed greater improvement than the usual care group in Mini-BESTest domains of balance (p = 0.014), postural control (p = 0.024), and dynamic walking (p = 0.020) at post-treatment. Higher adherence was registered for telerehabilitation compared with usual care (86.67% vs. 80.0%). DISCUSSION This study provides evidence that people with multiple sclerosis can benefit from telerehabilitation treatment in the physical domain of the quality of life and motor symptoms. Moreover, considering the persistent COVID-19 emergency, telerehabilitation can represent an effective telemedicine solution for safely delivering effective rehabilitation care to people with multiple sclerosis. TRIAL REGISTRATION NUMBER AND TRIAL REGISTER This trial was registered at ClinicalTrials.gov (NCT03444454).
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Affiliation(s)
| | - Sonia Di Tella
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Italy
| | | | | | - Marco Rovaris
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Roberto De Icco
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Tommaso Milanesi
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Michela Agostini
- Department of Neuroscience, Section of Rehabilitation, University-General Hospital of Padova, Italy
| | - Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Leonardo Pellicciari
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Marco Franceschini
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy
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Tang WK, Lu H, Leung TWH, Kim JS, Fong KNK. Study protocol of a double-blind randomized control trial of transcranial direct current stimulation in post-stroke fatigue. Front Neurol 2024; 14:1297429. [PMID: 38348114 PMCID: PMC10860680 DOI: 10.3389/fneur.2023.1297429] [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: 09/21/2023] [Accepted: 12/18/2023] [Indexed: 02/15/2024] Open
Abstract
Rationale Post-stroke fatigue (PSF) is a frequent problem in stroke survivors and often hinders their rehabilitation. PSF is difficult to treat, and pharmacological therapy is often ineffective. Transcranial direct current stimulation (tDCS) can modulate motor, sensory, cognitive and behavioral responses, as it alters neuronal activity by delivering a small amount of current via the scalp to the cortex, resulting in prolonged alterations to brain function. tDCS has been studied for the treatment of fatigue associated with other neurological diseases, namely, multiple sclerosis, Parkinson's disease and post-polio syndrome. Aims This proposed project will examine the effect of tDCS on PSF. Sample size estimates We will recruit 156 participants aged 18 to 80 with chronic stroke and allocate them equally to two groups (i.e., n = 78 per group). Methods and design This proposed project will be a double-blind randomized control trial. The participants will be randomly divided into two groups. The control group will receive sham tDCS, and the treatment group will receive active tDCS. The latter treatment will involve application of a constant 2-mA current via one 5 × 5-cm anodal electrode positioned on the scalp over the C3 or C4 positions (motor cortex) of the lesioned hemisphere and one cathodal electrode positioned at the ipsilateral shoulder in two 20-min sessions per day for 5 days. The period of follow-up will be 4 weeks. Study outcomes The primary outcome measure will be a change in fatigue severity, as measured using the modified fatigue impact scale (MFIS). The participants' scores on the MFIS (total score and physical, cognitive and psychosocial subscores) will be collected before treatment (T0), after 10 treatment sessions, i.e., 1 day after the fifth treatment day (T1), and 1 week (T2), 2 weeks (T3) and 4 weeks (T4) thereafter. Both per-protocol analysis and intention-to-treat analysis will be performed. Discussion This proposed project will provide proof-of-concept, i.e., demonstrate the benefits of tDCS for the treatment of PSF. The beneficiaries are the subjects participated in the study. This will stimulate further research to optimize tDCS parameters for the treatment of PSF. Clinical trial registration www.Chictr.org.cn, identifier: ChiCTR2100052515.
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Affiliation(s)
- Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Hanna Lu
- Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Thomas Wai Hong Leung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jong S. Kim
- Department of Neurology, Kangneung Asan Hospital, University of Ulsan, Ulsan, Republic of Korea
| | - Kenneth Nai Kuen Fong
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
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Hamilton K, Smith K, Winn K, Oliver B, Newland P, Hendricks-Ferguson V. Quantifying Fatigue Using Electrophysiological Techniques and Non-invasive Brain Stimulation in People With Multiple Sclerosis- A Review and Discussion. Biol Res Nurs 2024; 26:101-114. [PMID: 37558634 DOI: 10.1177/10998004231194954] [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] [Indexed: 08/11/2023]
Abstract
Objective: The purpose of this literature review article is to provide a synthesis of recent research focused on the use of 3 techniques to evaluate MS-related fatigue: electroencephalography [EEG], transcranial direct-current stimulation (tDSC), and transcranial- magnetic stimulation (TMS). Method: We performed a literature search in the Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCOhost), MEDLINE (OVID), APA PsycInfo (OVID), Scopus (Elsevier), and Web of Science (Clarivate) databases, limited to 2015 and after. Results: Our review revealed that fatigue in MS patients can be quantified and predicted using electrophysiological techniques. Such techniques, which yield objective data, are historically assessed in relation to subjective data, or perceived fatigue. We identified studies using EEG, TMS, and/or tDCS to study fatigue in people with MS. In total, 220 records were identified with 19 studies meeting inclusion criteria. Quality appraisal revealed that the level of evidence was generally graded "good". Conclusions: Despite the heterogenous nature of reviewed the studies and selected the varied self-report fatigue measures, our literature synthesis suggests promise for the use of EEG, TMS, and/or tDCS approaches in more accurately assessing fatigue in people with MS. Further research is needed in this arena.
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Affiliation(s)
- Karlie Hamilton
- Valentine School of Nursing at Saint Louis University, Saint Louis, MO, USA
| | - Katy Smith
- Valentine School of Nursing at Saint Louis University, Saint Louis, MO, USA
| | | | - Brant Oliver
- Care Experience, Value Institute, Dartmouth Health, Lebanon, NH, USA
- Departments of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Psychiatry and the Dartmouth Institute, Hanover and Lebanon, NH, USA
| | - Pamela Newland
- Goldfarb School of Nursing at Barnes Jewish College, Saint Louis, MO, USA
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Jagadish A, Shankaranarayana AM, Natarajan M, Solomon JM. Transcranial direct current stimulation for fatigue in neurological conditions: A systematic scoping review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2054. [PMID: 37838979 DOI: 10.1002/pri.2054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND AND PURPOSE Fatigue following neurological conditions negatively impacts daily activities, reducing overall quality of life. Transcranial direct current stimulation (tDCS) for fatigue management is still underexplored. This scoping review explores its use in managing fatigue among various neurological conditions. METHODS A thorough literature search was carried out using PubMed, Scopus, CINAHL, Web of Science, Embase, ProQuest, and the Cochrane Library. Google Scholar and clinicaltrials.gov were manually searched for gray literature and ongoing trials, respectively. Regardless of the study design, all studies utilizing tDCS for the management of fatigue in various neurological conditions were considered. Two reviewers independently screened all the studies, following which the data were retrieved. RESULTS Studies employing tDCS for fatigue management across neurological conditions is as follows: Multiple sclerosis (MS) (n = 28, 66%), stroke (n = 5, 12%), Parkinson's disease (PD) (n = 4, 10%), post-polio syndrome (PPS) (n = 2, 5%), traumatic brain injury (TBI) (n = 2, 5%), and amyotrophic lateral sclerosis (n = 1, 2%). All the studies used anodal stimulation, with the common stimulation site being the left dorsolateral prefrontal cortex for MS, stroke, and PD. A stimulation intensity of 1.0-4.0 mA with a duration ranging from 15 to 30 min in 1 to 24 sessions were commonly reported. The Fatigue Severity Scale (n = 21) and Modified Fatigue Impact Scale (n = 17) were frequently implemented outcome measures. Regardless of the study design, 36/42 (85.7%) studies reported an improvement in fatigue scores in the tDCS group. The common adverse events noted were tingling (n = 8, 35%), headache (n = 6, 26%), and itching (n = 6, 26%). DISCUSSION Application of tDCS for fatigue was explored in individuals with stroke, PD, PPS, and TBI after MS. Even though a wide range of treatment parameters and outcome measures were adopted to assess and target fatigue, tDCS proves to have a promising role in alleviating this symptom.
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Affiliation(s)
- Akhila Jagadish
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Apoorva M Shankaranarayana
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Pinarello C, Elmers J, Inojosa H, Beste C, Ziemssen T. Management of multiple sclerosis fatigue in the digital age: from assessment to treatment. Front Neurosci 2023; 17:1231321. [PMID: 37869507 PMCID: PMC10585158 DOI: 10.3389/fnins.2023.1231321] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Fatigue is one of the most disabling symptoms of Multiple Sclerosis (MS), affecting more than 80% of patients over the disease course. Nevertheless, it has a multi-faceted and complex nature, making its diagnosis, evaluation, and treatment extremely challenging in clinical practice. In the last years, digital supporting tools have emerged to support the care of people with MS. These include not only smartphone or table-based apps, but also wearable devices or novel techniques such as virtual reality. Furthermore, an additional effective and cost-efficient tool for the therapeutic management of people with fatigue is becoming increasingly available. Virtual reality and e-Health are viable and modern tools to both assess and treat fatigue, with a variety of applications and adaptability to patient needs and disability levels. Most importantly, they can be employed in the patient's home setting and can not only bridge clinic visits but also be complementary to the monitoring and treatment means for those MS patients who live far away from healthcare structures. In this narrative review, we discuss the current knowledge and future perspectives in the digital management of fatigue in MS. These may also serve as sources for research of novel digital biomarkers in the identification of disease activity and progression.
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Affiliation(s)
- Chiara Pinarello
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Julia Elmers
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technical University of Dresden, Dresden, Germany
| | - Hernán Inojosa
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technical University of Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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Uygur-Kucukseymen E, Pacheco-Barrios K, Yuksel B, Gonzalez-Mego P, Soysal A, Fregni F. Non-invasive brain stimulation on clinical symptoms in multiple sclerosis patients: A systematic review and meta-analysis. Mult Scler Relat Disord 2023; 78:104927. [PMID: 37595371 DOI: 10.1016/j.msard.2023.104927] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Non-invasive brain stimulation (NIBS) has demonstrated mixed effects on the clinical symptoms of multiple sclerosis. This systematic review and meta-analysis aimed to evaluate the effects of NIBS techniques on the most common symptoms of MS. METHODS A literature search was performed until October 2022 which included randomized controlled trials and quasi-experimental studies that used sham-controlled NIBS in patients with MS. We calculated the Hedge's effect sizes of each domain of interest and their 95% confidence intervals (95% CIs) and performed random effects meta-analyses. RESULTS A total of 49 studies were included in the systematic review (944 participants). Forty-four eligible studies were included for quantitative analysis, of which 33 applied transcranial direct current stimulation (tDCS), 9 transcranial magnetic stimulation (TMS), and 2 transcranial random noise stimulation (tRNS). We found a significant decrease in fatigue (ES: - 0.86, 95% CI: - 1.22 to - 0.51, p < 0.0001), pain (ES: - 1.91, 95% CI, - 3.64 to - 0.19, p= 0.03) and psychiatric symptoms (ES: - 1.44, 95% CI - 2.56 to - 0.32, p = 0.01) in favor of tDCS compared with the sham. On the other hand, there was no strong evidence showing tDCS effectiveness on motor performance and cognition (ES: - 0.03, 95% CI - 0.35 to 0.28, p = 0.83 and ES: 0.71, 95% CI, - 0.09 to 1.52, p = 0.08, respectively). Regarding TMS, we found a significant decrease in fatigue (ES: - 0.45, 95% CI: - 0.84 to -0.07, p = 0.02) and spasticity levels (ES: - 1.11, 95% CI: - 1.48 to - 0.75, p < 0.00001) compared to the sham. However, there was no strong evidence of the effectiveness of TMS on motor performance (ES: - 0.39, 95% CI - 0.95 to 0.16, p = 0.16). Finally, there was no significant evidence showing the effectiveness of tRNS on fatigue levels (ES: - 0.28, 95% CI: - 1.02 to 0.47, p = 0.46) and cognitive improvement (ES: - 0.04, 95% CI: - 0.6, 0.52, p = 0.88) compared with the sham. CONCLUSIONS Overall, most studies have investigated the effects of tDCS on MS symptoms, particularly fatigue. The symptom that most benefited from NIBS was fatigue, while the least to benefit was motor performance. In addition, we found that disability score was associated with fatigue improvement. Thus, these findings support the idea that NIBS could have some promising effects on specific MS symptoms. It is also important to underscore that studies are very heterogeneous regarding the parameters of stimulation, and this may also have influenced the effects on some specific behavioral domains.
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Affiliation(s)
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Unidad de Investigacion para la Generacion y Sintesis de Evidencia en Salud, Universidad San Ignacio de Loyola, Vicerrectorado de Investigacion, Lima, Peru
| | - Burcu Yuksel
- Istanbul Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Clinic of Neurology and Neurosurgery, Istanbul, Turkey
| | - Paola Gonzalez-Mego
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aysun Soysal
- Istanbul Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Clinic of Neurology and Neurosurgery, Istanbul, Turkey
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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13
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Raizen DM, Mullington J, Anaclet C, Clarke G, Critchley H, Dantzer R, Davis R, Drew KL, Fessel J, Fuller PM, Gibson EM, Harrington M, Ian Lipkin W, Klerman EB, Klimas N, Komaroff AL, Koroshetz W, Krupp L, Kuppuswamy A, Lasselin J, Lewis LD, Magistretti PJ, Matos HY, Miaskowski C, Miller AH, Nath A, Nedergaard M, Opp MR, Ritchie MD, Rogulja D, Rolls A, Salamone JD, Saper C, Whittemore V, Wylie G, Younger J, Zee PC, Craig Heller H. Beyond the symptom: the biology of fatigue. Sleep 2023; 46:zsad069. [PMID: 37224457 PMCID: PMC10485572 DOI: 10.1093/sleep/zsad069] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/24/2023] [Indexed: 05/26/2023] Open
Abstract
A workshop titled "Beyond the Symptom: The Biology of Fatigue" was held virtually September 27-28, 2021. It was jointly organized by the Sleep Research Society and the Neurobiology of Fatigue Working Group of the NIH Blueprint Neuroscience Research Program. For access to the presentations and video recordings, see: https://neuroscienceblueprint.nih.gov/about/event/beyond-symptom-biology-fatigue. The goals of this workshop were to bring together clinicians and scientists who use a variety of research approaches to understand fatigue in multiple conditions and to identify key gaps in our understanding of the biology of fatigue. This workshop summary distills key issues discussed in this workshop and provides a list of promising directions for future research on this topic. We do not attempt to provide a comprehensive review of the state of our understanding of fatigue, nor to provide a comprehensive reprise of the many excellent presentations. Rather, our goal is to highlight key advances and to focus on questions and future approaches to answering them.
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Affiliation(s)
- David M Raizen
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Mullington
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Christelle Anaclet
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Gerard Clarke
- Department of Psychiatry and Neurobehavioural Science, and APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Hugo Critchley
- Brighton and Sussex Medical School Department of Neuroscience, University of Sussex, Brighton, UK
| | - Robert Dantzer
- Department of Symptom Research, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ronald Davis
- Department of Biochemistry and Genetics, Stanford University, Palo Alto, CA, USA
| | - Kelly L Drew
- Department of Chemistry and Biochemistry, Institute of Arctic Biology, Center for Transformative Research in Metabolism, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Josh Fessel
- Division of Clinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Patrick M Fuller
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Erin M Gibson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Mary Harrington
- Department of Psychology, Neuroscience Program, Smith College, Northampton, MA, USA
| | - W Ian Lipkin
- Center for Infection and Immunity, and Departments of Neurology and Pathology, Columbia University, New York City, NY, USA
| | - Elizabeth B Klerman
- Division of Sleep Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Nancy Klimas
- Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Anthony L Komaroff
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Walter Koroshetz
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Lauren Krupp
- Department of Neurology, NYU Grossman School of Medicine, NYC, NY, USA
| | - Anna Kuppuswamy
- University College London, Queen Square Institute of Neurology, London, England
| | - Julie Lasselin
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Laura D Lewis
- Center for Systems Neuroscience, Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Pierre J Magistretti
- Biological and Environmental Science and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Kingdom of Saudi Arabia
| | - Heidi Y Matos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Andrew H Miller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Avindra Nath
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Maiken Nedergaard
- Departments of Neurology and Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Mark R Opp
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Marylyn D Ritchie
- Department of Genetics, Institute for Biomedical Informatics, Penn Center for Precision Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dragana Rogulja
- Department of Neurobiology, Harvard University, Boston, MA, USA
| | - Asya Rolls
- Rappaport Institute for Medical Research, Technion, Israel Institute of Technology, Haifa, Israel
| | - John D Salamone
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Clifford Saper
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Vicky Whittemore
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Glenn Wylie
- Rocco Ortenzio Neuroimaging Center at Kessler Foundation, East Hanover, NJ, USA
| | - Jarred Younger
- Department of Psychology, University of Alabama, Birmingham, Birmingham, AL, USA
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - H Craig Heller
- Department of Biology, Stanford University and Sleep Research Society, Stanford, CA, USA
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14
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De Guzman KA, Young RJ, Contini V, Clinton E, Hitchcock A, Riley ZA, Poston B. The Influence of Transcranial Alternating Current Stimulation on Fatigue Resistance. Brain Sci 2023; 13:1225. [PMID: 37626581 PMCID: PMC10452200 DOI: 10.3390/brainsci13081225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Previous research has shown that some forms of non-invasive brain stimulation can increase fatigue resistance. The purpose of this study is to determine the influence of transcranial alternating current stimulation (tACS) on the time to task failure (TTF) of a precision grip task. The study utilized a randomized, double-blind, SHAM-controlled, within-subjects design. Twenty-six young adults completed two experimental sessions (tACS and SHAM) with a 7-day washout period between sessions. Each session involved a fatiguing isometric contraction of the right hand with a precision grip with either a tACS or SHAM stimulation applied to the primary motor cortex (M1) simultaneously. For the fatiguing contraction, the participants matched an isometric target force of 20% of the maximum voluntary contraction (MVC) force until task failure. Pre- and post-MVCs were performed to quantify the force decline due to fatigue. Accordingly, the dependent variables were the TTF and MVC force decline as well as the average EMG activity, force error, and standard deviation (SD) of force during the fatiguing contractions. The results indicate that there were no significant differences in any of the dependent variables between the tACS and SHAM conditions (p value range: 0.256-0.820). These findings suggest that tACS does not increase the TTF during fatiguing contractions in young adults.
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Affiliation(s)
- Kayla A. De Guzman
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (K.A.D.G.); (E.C.)
| | - Richard J. Young
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (K.A.D.G.); (E.C.)
- Optum Labs, Minnetonka, MN 55343, USA
| | - Valentino Contini
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (K.A.D.G.); (E.C.)
| | - Eliza Clinton
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (K.A.D.G.); (E.C.)
| | - Ashley Hitchcock
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (K.A.D.G.); (E.C.)
| | - Zachary A. Riley
- Department of Kinesiology, Indiana University—Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Brach Poston
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (K.A.D.G.); (E.C.)
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Charvet L, Harrison AT, Mangold K, Moore RD, Guo S, Zhang J, Datta A, Androulakis XM. Remotely supervised at-home tDCS for veterans with persistent post-traumatic headache: a double-blind, sham-controlled randomized pilot clinical trial. Front Neurol 2023; 14:1184056. [PMID: 37213913 PMCID: PMC10196360 DOI: 10.3389/fneur.2023.1184056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/14/2023] [Indexed: 05/23/2023] Open
Abstract
Background Currently, there are no FDA approved therapies for persistent post-traumatic headache (PPTH) secondary to traumatic brain injury (TBI). As such neither headache nor TBI specialists have an effective means to manage PPTH. Thus, the objective of the present pilot trial was to evaluate the feasibility and preliminary efficacy of a four-week at-home remotely supervised transcranial direct current stimulation (RS-tDCS) intervention for veterans with PPTH. Methods Twenty-five (m = 46.6 ± 8.7 years) veterans with PPTH were randomized into two groups and received either active (n = 12) or sham (n = 13) RS-tDCS, with anodal stimulation over left dlPFC and cathodal over occipital pole. Following a four-week baseline, participants completed 20-sessions of active or sham RS-tDCS with real-time video monitoring over a period of four-weeks. Participants were assessed again at the end of the intervention and at four-weeks post-intervention. Primary outcomes were overall adherence rate (feasibility) and change in moderate-to-severe headache days per month (efficacy). Secondary outcomes were changes in total number of headache days, and PPTH-related functional outcomes. Results Adherence rate was high with 88% of participants (active = 10/12; sham = 12/13) fully completing tDCS interventions. Importantly, there was no significant difference in adherence between active and sham groups (p = 0.59). Moderate-to-severe headache days were significantly reduced within the active RS-tDCS group (p = 0.004), compared to sham during treatment (-2.5 ± 3.5 vs. 2.3 ± 3.4), and 4-week follow-up (-3.9 ± 6.4 vs. 1.2 ± 6.5). Total number of headache days was significantly reduced within the active RS-tDCS (p = 0.03), compared to sham during-treatment (-4.0 ± 5.2 vs. 1.5 ± 3.8), and 4-week follow-up (-2.1 ± 7.2 vs. -0.2 ± 4.4). Conclusion The current results indicate our RS-tDCS paradigm provides a safe and effective means for reducing the severity and number of headache days in veterans with PPTH. High treatment adherence rate and the remote nature of our paradigm indicate RS-tDCS may be a feasible means to reduce PPTH, especially for veterans with limited access to medical facilities.Clinical Trial Registration: ClinicalTrials.gov, identifier [NCT04012853].
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Affiliation(s)
- Leigh Charvet
- Department of Neurology, New York University Langone Health, New York, NY, United States
| | - Adam T. Harrison
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Neurology, Columbia VA Healthcare System, Columbia, SC, United States
| | - Kiersten Mangold
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Neurology, Columbia VA Healthcare System, Columbia, SC, United States
| | - Robert Davis Moore
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Siyuan Guo
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, United States
| | - Jiajia Zhang
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Abhishek Datta
- Research and Development, Soterix Medical, Inc., Woodbridge, NJ, United States
- Department of Biomedical Engineering, City College of New York, New York, NY, United States
| | - X. Michelle Androulakis
- Department of Neurology, Columbia VA Healthcare System, Columbia, SC, United States
- Headache Centers of Excellence Program, US Department of Veterans Affairs, Columbia, SC, United States
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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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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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Linnhoff S, Haghikia A, Zaehle T. Effects of repetitive twice-weekly transcranial direct current stimulations on fatigue and fatigability in people with multiple sclerosis. Sci Rep 2023; 13:5878. [PMID: 37041183 PMCID: PMC10090173 DOI: 10.1038/s41598-023-32779-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/02/2023] [Indexed: 04/13/2023] Open
Abstract
Fatigue is associated with a dramatically decreased quality of life in people with multiple sclerosis (pwMS). It refers to a constant subjective feeling of exhaustion and performance decline, known as fatigability. However, inconsistency and heterogeneity in defining and assessing fatigue have led to limited advances in understanding and treating MS-associated fatigue. Transcranial direct current stimulation (tDCS) has emerged as a promising, non-pharmaceutical treatment strategy for subjective fatigue. However, whether repetitive tDCS also have long-term effects on time-on-task performance has not yet been investigated. This pseudorandomized, single-blinded, and sham-controlled study investigated tDCS effects on behavioral and electrophysiological parameters. 18 pwMS received eight twice-weekly 30 min stimulations over the left dorsolateral prefrontal cortex. Fatigability was operationalized as time-on-task-related changes in reaction time variability and P300 amplitude. Additionally, subjective trait and state fatigue ratings were assessed. The results revealed an overall decrease in subjective trait fatigue ratings that lasted at least four weeks after the stimulations. However, the ratings declined after both anodal and sham tDCS. No effects were found on subjective state fatigue and objective fatigability parameters. Linear Mixed Models and Bayesian Regression models likewise favored the absence of a tDCS effect on fatigability parameters. The results confirm the complex relationship between MS-associated fatigue and fatigability. Reliable and clinically relevant parameters need to be established to extend the potential of tDCS for treating fatigability. Furthermore, our results indicate that consecutive stimulations rather than twice-weekly stimulations should be the preferred stimulation scheme in future studies.
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Affiliation(s)
- Stefanie Linnhoff
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, 39120, Magdeburg, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, 39120, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39106, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), 39120, Magdeburg, Germany
| | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, 39120, Magdeburg, Germany.
- Center for Behavioral Brain Sciences (CBBS), 39106, Magdeburg, Germany.
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19
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Garjani A, Liu BJY, Allen CM, Gunzler DD, Gerry SW, Planchon SM, das Nair R, Chataway J, Tallantyre EC, Ontaneda D, Evangelou N. Decentralised clinical trials in multiple sclerosis research. Mult Scler 2023; 29:317-325. [PMID: 35735014 PMCID: PMC9972228 DOI: 10.1177/13524585221100401] [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] [Indexed: 11/15/2022]
Abstract
Randomised controlled trials (RCTs) play an important role in multiple sclerosis (MS) research, ensuring that new interventions are safe and efficacious before their introduction into clinical practice. Trials have been evolving to improve the robustness of their designs and the efficiency of their conduct. Advances in digital and mobile technologies in recent years have facilitated this process and the first RCTs with decentralised elements became possible. Decentralised clinical trials (DCTs) are conducted remotely, enabling participation of a more heterogeneous population who can participate in research activities from different locations and at their convenience. DCTs also rely on digital and mobile technologies which allows for more flexible and frequent assessments. While hospitals quickly adapted to e-health and telehealth assessments during the COVID-19 pandemic, the conduct of conventional RCTs was profoundly disrupted. In this paper, we review the existing evidence and gaps in knowledge in the design and conduct of DCTs in MS.
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Affiliation(s)
- Afagh Garjani
- Mental Health and Clinical Neurosciences
Academic Unit, School of Medicine, University of Nottingham, Nottingham,
UK/Academic Neurology, Nottingham University Hospitals NHS Trust,
Nottingham, UK
| | | | - Christopher Martin Allen
- Mental Health and Clinical Neurosciences
Academic Unit, School of Medicine, University of Nottingham, Nottingham,
UK/Academic Neurology, Nottingham University Hospitals NHS Trust,
Nottingham, UK
| | | | - Stephen William Gerry
- Centre for Statistics in Medicine, Nuffield
Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences,
University of Oxford, Oxford, UK
| | | | - Roshan das Nair
- Mental Health and Clinical Neurosciences
Academic Unit, School of Medicine, University of Nottingham, Nottingham,
UK/Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation
Trust, Nottingham, UK
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre,
Department of Neuroinflammation, UCL Queen Square Institute of Neurology,
Faculty of Brain Sciences, University College London, London, UK/National
Institute for Health Research, University College London Hospitals
Biomedical Research Centre, London, UK/MRC CTU at UCL, Institute of Clinical
Trials and Methodology, University College London, London, UK
| | - Emma C Tallantyre
- Helen Durham Neuro-Inflammatory Unit,
University Hospital of Wales, Cardiff, UK/Division of Psychological Medicine
and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis,
Cleveland Clinic, Cleveland, OH, USA
| | - Nikos Evangelou
- N Evangelou Academic Neurology, Nottingham
University Hospitals NHS Trust, C Floor, South Block, Queen’s Medical Centre,
Nottingham NG7 2UH, UK. ;
@nikosevangelou3
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20
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Gebodh N, Miskovic V, Laszlo S, Datta A, Bikson M. A Scalable Framework for Closed-Loop Neuromodulation with Deep Learning. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.18.524615. [PMID: 36712027 PMCID: PMC9882307 DOI: 10.1101/2023.01.18.524615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Closed-loop neuromodulation measures dynamic neural or physiological activity to optimize interventions for clinical and nonclinical behavioral, cognitive, wellness, attentional, or general task performance enhancement. Conventional closed-loop stimulation approaches can contain biased biomarker detection (decoders and error-based triggering) and stimulation-type application. We present and verify a novel deep learning framework for designing and deploying flexible, data-driven, automated closed-loop neuromodulation that is scalable using diverse datasets, agnostic to stimulation technology (supporting multi-modal stimulation: tACS, tDCS, tFUS, TMS), and without the need for personalized ground-truth performance data. Our approach is based on identified periods of responsiveness - detected states that result in a change in performance when stimulation is applied compared to no stimulation. To demonstrate our framework, we acquire, analyze, and apply a data-driven approach to our open sourced GX dataset, which includes concurrent physiological (ECG, EOG) and neuronal (EEG) measures, paired with continuous vigilance/attention-fatigue tracking, and High-Definition transcranial electrical stimulation (HD-tES). Our framework's decision process for intervention application identified 88.26% of trials as correct applications, showed potential improvement with varying stimulation types, or missed opportunities to stimulate, whereas 11.25% of trials were predicted to stimulate at inopportune times. With emerging datasets and stimulation technologies, our unifying and integrative framework; leveraging deep learning (Convolutional Neural Networks - CNNs); demonstrates the adaptability and feasibility of automated multimodal neuromodulation for both clinical and nonclinical applications.
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Affiliation(s)
- Nigel Gebodh
- The Department of Biomedical Engineering, The City College of New York, The City University of New York, New York USA
| | | | | | | | - Marom Bikson
- The Department of Biomedical Engineering, The City College of New York, The City University of New York, New York USA
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21
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Linnhoff S, Koehler L, Haghikia A, Zaehle T. The therapeutic potential of non-invasive brain stimulation for the treatment of Long-COVID-related cognitive fatigue. Front Immunol 2023; 13:935614. [PMID: 36700201 PMCID: PMC9869163 DOI: 10.3389/fimmu.2022.935614] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Following an acute COVID-19 infection, a large number of patients experience persisting symptoms for more than four weeks, a condition now classified as Long-COVID syndrome. Interestingly, the likelihood and severity of Long-COVID symptoms do not appear to be related to the severity of the acute COVID-19 infection. Fatigue is amongst the most common and debilitating symptoms of Long-COVID. Other symptomes include dyspnoea, chest pain, olfactory disturbances, and brain fog. Fatigue is also frequently reported in many other neurological diseases, affecting a broad range of everyday activities. However, despite its clinical significance, limited progress has been made in understanding its causes and developing effective treatment options. Non-invasive brain stimulation (NIBS) methods offer the unique opportunity to modulate fatigue-related maladaptive neuronal activity. Recent data show promising results of NIBS applications over frontoparietal regions to reduce fatigue symptoms. In this current paper, we review recent data on Long-COVID and Long-COVID-related fatigue (LCOF), with a special focus on cognitive fatigue. We further present widely used NIBS methods, such as transcranial direct current stimulation, transcranial alternating current stimulation, and transcutaneous vagus nerve stimulation and propose their use as possible therapeutic strategies to alleviate individual pathomechanisms of LCOF. Since NIBS methods are safe and well-tolerated, they have the potential to enhance the quality of life in a broad group of patients.
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Affiliation(s)
- Stefanie Linnhoff
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Lilli Koehler
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany,*Correspondence: Tino Zaehle,
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22
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Schwell G, Kozol Z, Tarshansky D, Einat M, Frenkel-Toledo S. The effect of action observation combined with high-definition transcranial direct current stimulation on motor performance in healthy adults: A randomized controlled trial. Front Hum Neurosci 2023; 17:1126510. [PMID: 36936614 PMCID: PMC10014919 DOI: 10.3389/fnhum.2023.1126510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/14/2023] [Indexed: 03/05/2023] Open
Abstract
Action observation (AO) can improve motor performance in humans, probably via the human mirror neuron system. In addition, there is some evidence that transcranial direct current stimulation (tDCS) can improve motor performance. However, it is yet to be determined whether AO combined with tDCS has an enhanced effect on motor performance. We investigated the effect of AO combined with high-definition tDCS (HD-tDCS) targeting the inferior parietal lobe (IPL) and inferior frontal gyrus (IFG), the main aggregates of the human mirror neuron system, on motor performance in healthy adults and compared the immediate vs. 24-h retention test effects (anodal electrodes were placed over these regions of interest). Sixty participants were randomly divided into three groups that received one of the following single-session interventions: (1) observation of a video clip that presented reaching movement sequences toward five lighted units + active HD-tDCS stimulation (AO + active HD-tDCS group); (2) observation of a video clip that presented the same reaching movement sequences + sham HD-tDCS stimulation (AO + sham HD-tDCS group); and (3) observation of a video clip that presented neutral movie while receiving sham stimulation (NM + sham HD-tDCS group). Subjects' reaching performance was tested before and immediately after each intervention and following 24 h. Subjects performed reaching movements toward units that were activated in the same order as the observed sequence during pretest, posttest, and retest. Occasionally, the sequence order was changed by beginning the sequence unexpectedly with a different activated unit. Outcome measures included mean Reaching Time and difference between the Reaching Time of the unexpected and expected reaching movements (Delta). In the posttest and retest, Reaching Time and Delta improved in the AO + sham HD-tDCS group compared to the NM + HD-sham tDCS group. In addition, at posttest, Delta improved in the AO + active HD-tDCS group compared to the NM + sham HD-tDCS group. It appears that combining a montage of active HD-tDCS, which targets the IPL and IFG, with AO interferes with the positive effects of AO alone on the performance of reaching movement sequences.
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Affiliation(s)
- Gidon Schwell
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
| | - Zvi Kozol
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
| | - David Tarshansky
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
| | - Moshe Einat
- Department of Electrical and Electronic Engineering, Ariel University, Ariel, Israel
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra’anana, Israel
- *Correspondence: Silvi Frenkel-Toledo,
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23
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Kaye HL, San-Juan D, Salvador R, Biagi MC, Dubreuil-Vall L, Damar U, Pascual-Leone A, Ruffini G, Shafi MM, Rotenberg A. Personalized, Multisession, Multichannel Transcranial Direct Current Stimulation in Medication-Refractory Focal Epilepsy: An Open-Label Study. J Clin Neurophysiol 2023; 40:53-62. [PMID: 34010226 DOI: 10.1097/wnp.0000000000000838] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Animal and proof-of-principle human studies suggest that cathodal transcranial direct current stimulation may suppress seizures in drug-resistant focal epilepsy. The present study tests the safety, tolerability, and effect size of repeated daily cathodal transcranial direct current stimulation in epilepsy have not been established, limiting development of clinically meaningful interventions. METHODS We conducted a 2-center, open-label study on 20 participants with medically refractory, focal epilepsy, aged 9 to 56 years (11 women and 9 children younger than18 years). Each participant underwent 10 sessions of 20 minutes of cathodal transcranial direct current stimulation over 2 weeks. Multielectrode montages were designed using a realistic head model-driven approach to conduct an inhibitory electric field to the target cortical seizure foci and surrounding cortex to suppress excitability and reduce seizure rates. Patients recorded daily seizures using a seizure diary 8 weeks prior, 2 weeks during, and 8 to 12 weeks after the stimulation period. RESULTS The median seizure reduction was 44% relative to baseline and did not differ between adult and pediatric patients. Three patients experienced an increase in seizure frequency of >50% during the stimulation period; in one, a 36% increase in seizure frequency persisted through 12 weeks of follow-up. Otherwise, participants experienced only minor adverse events-the most common being scalp discomfort during transcranial direct current stimulation. CONCLUSIONS This pilot study supports the safety and efficacy of multifocal, personalized, multichannel, cathodal transcranial direct current stimulation for adult and pediatric patients with medication-refractory focal epilepsy, although identifies a possibility of seizure exacerbation in some. The data also provide insight into the effect size to inform the design of a randomized, sham-stimulation controlled trial.
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Affiliation(s)
- Harper Lee Kaye
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- F. M. Kirby Neurobiology Center; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- Behavioral Neuroscience Program, Division of Medical Sciences, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Daniel San-Juan
- Clinical Neurophysiology Department, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | | | | | | | - Ugur Damar
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- F. M. Kirby Neurobiology Center; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew Senior Life, Department of Neurology, Harvard Medical School, Boston, Massachusetts, U.S.A
- Guttmann Brain Health Institute, Institut Gutmann, Universitat Autonoma, Barcelona, Spain
| | - Giulio Ruffini
- Neuroelectrics Barcelona, Barcelona, Spain
- Neuroelectrics Corporation, Cambridge, U.S.A.; and
| | - Mouhsin M Shafi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Alexander Rotenberg
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- F. M. Kirby Neurobiology Center; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
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24
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Muccio M, Walton Masters L, Pilloni G, He P, Krupp L, Datta A, Bikson M, Charvet L, Ge Y. Cerebral metabolic rate of oxygen (CMRO 2) changes measured with simultaneous tDCS-MRI in healthy adults. Brain Res 2022; 1796:148097. [PMID: 36150457 PMCID: PMC10335216 DOI: 10.1016/j.brainres.2022.148097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a safe and well-tolerated noninvasive technique used for cortical excitability modulation. tDCS has been extensively investigated for its clinical applications; however further understanding of its underlying in-vivo physiological mechanisms remains a fundamental focus of current research. OBJECTIVES We investigated the simultaneous effects of tDCS on cerebral blood flow (CBF), venous blood oxygenation (Yv) and cerebral metabolic rate of oxygen (CMRO2) using simultaneous MRI in healthy adults to provide a reference frame for its neurobiological mechanisms. METHODS Twenty-three healthy participants (age = 35.6 ± 15.0 years old, 10 males) completed a simultaneous tDCS-MRI session in a 3 T scanner fitted with a 64-channels head coil. A MR-compatible tDCS device was used to acquire CBF, Yv and CMRO2 at three time points: pre-, during- and post- 15 minutes of 2.0 mA tDCS on left anodal dorsolateral prefrontal cortex. RESULTS During tDCS, CBF significantly increased (57.10 ± 8.33 mL/100g/min) from baseline (53.67 ± 7.75 mL/100g/min; p < 0.0001) and remained elevated in post-tDCS (56.79 ± 8.70 mL/100g/min). Venous blood oxygenation levels measured in pre-tDCS (60.71 ± 4.12 %) did not significantly change across the three timepoints. The resulting CMRO2 significantly increased by 5.9 % during-tDCS (175.68 ± 30.78 µmol/100g/min) compared to pre-tDCS (165.84 ± 25.32 µmol/100g/min; p = 0.0015), maintaining increased levels in post-tDCS (176.86 ± 28.58 µmol/100g/min). CONCLUSIONS tDCS has immediate effects on neuronal excitability, as measured by increased cerebral blood supply and oxygen consumption supporting increased neuronal firing. These findings provide a standard range of CBF and CMRO2 changes due to tDCS in healthy adults that may be incorporated in clinical studies to evaluate its therapeutic potential.
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Affiliation(s)
- Marco Muccio
- Department of Radiology, NYU Grossman School of Medicine, New York City, NY, United States
| | - Lillian Walton Masters
- Department of Neurology, NYU Grossman School of Medicine, New York City, NY, United States
| | - Giuseppina Pilloni
- Department of Neurology, NYU Grossman School of Medicine, New York City, NY, United States
| | - Peidong He
- Department of Radiology, NYU Grossman School of Medicine, New York City, NY, United States
| | - Lauren Krupp
- Department of Neurology, NYU Grossman School of Medicine, New York City, NY, United States
| | - Abhishek Datta
- Research and Development, Soterix Medical, Inc, Woodbridge, NJ, United States
| | - Marom Bikson
- Department of Biomedical Engineering, City College of New York, New York City, NY, United States
| | - Leigh Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York City, NY, United States
| | - Yulin Ge
- Department of Radiology, NYU Grossman School of Medicine, New York City, NY, United States.
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25
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Zhang X, Huai Y, Wei Z, Yang W, Xie Q, Yi L. Non-invasive brain stimulation therapy on neurological symptoms in patients with multiple sclerosis: A network meta analysis. Front Neurol 2022; 13:1007702. [PMID: 36457862 PMCID: PMC9705977 DOI: 10.3389/fneur.2022.1007702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/31/2022] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE The aim of the study was to evaluate non-invasive brain stimulation (NIBS) [including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES)] on neurological symptoms in patients with multiple sclerosis (PwMS). METHOD We searched PubMed, Embase, Cochrane Library, Web of Science and Ovid MEDLINE until February 2022. And we evaluated the included studies for methodological quality by the Cochrane bias risk assessment tool and assessed the studies' certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. We performed network meta analysis (NMA) by using Stata 15 and ranked the results of the NMA by using the surface under the cumulative ranking curve (SUCRA) ranking chart. RESULT Twenty seven clinical trials were finally included (N = 596, 66.4% women). For the immediate effects, rTMS over M1 yielded the most optimal scheme for fatigue reduction among all the interventions compared to the sham stimulation groups [MD = -0.85, 95% CI (-1.57, -0.14)] (SUCRA = 82.6%). iTBS over M1 yielded the most signifcant reduced pain level than the sham groups did [MD = -1.26, 95% CI (-2.40, -0.11)] (SUCRA = 98.4%). tDCS over F3 was the best protocol of NIBS to improve quality of life (QOL) [MD = 1.41, 95% CI = (0.45,2.36)] (SUCRA = 76.7%), and iTBS over M1 may significantly reduce spasticity compared to sham stimulation [MD = -1.20, 95% CI = (-1.99, -0.41)] (SUCRA = 90.3%). Furthermore, rTMS, tRNS, and tDCS on certain areas may improve PwMS accuracy, response time, manual dexterity, pain relief and QOL, but does not show statistically significant differences. The evidence assessed using GRADE is very low. CONCLUSION Based on the NMA and SUCRA ranking, we can conclude that symptoms including fatigue, pain, spasticity, and QOL can be improved by following NIBS protocol after treatment. Nonetheless, most of the included studies lack a good methodology, and more high-quality randomized clinical trials are needed.
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Affiliation(s)
- Xiaoyun Zhang
- Rehabilitation Department, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, China
- Shenzhen Longhua District Rehabilitation Medical Equipment Development and Transformation Joint Key Laboratory, Shenzhen, Guangdong, China
| | - Yaping Huai
- Rehabilitation Department, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, China
- Shenzhen Longhua District Rehabilitation Medical Equipment Development and Transformation Joint Key Laboratory, Shenzhen, Guangdong, China
| | - Zhiqiang Wei
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Weiwei Yang
- Rehabilitation Department, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, China
| | - Qizhi Xie
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Li Yi
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
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26
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Rahimibarghani S, Azadvari M, Emami-Razavi SZ, Harirchian MH, Rahimi-Dehgolan S, Fateh HR. Effects of Nonconsecutive Sessions of Transcranial Direct Current Stimulation and Stationary Cycling on Walking Capacity in Individuals With Multiple Sclerosis. Int J MS Care 2022; 24:202-208. [PMID: 36090241 PMCID: PMC9461723 DOI: 10.7224/1537-2073.2021-004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
BACKGROUND Exercise has been demonstrated to be safe and well-tolerated in individuals with multiple sclerosis (MS). Physical activity has been shown to enhance the therapeutic effects of transcranial direct current stimulation (tDCS). This study aimed to determine the efficacy of intermittent tDCS combined with riding a stationary bicycle to improve walking capacity in individuals with MS. METHODS This double-blind randomized controlled trial enrolled 50 eligible participants. Thirty-nine participants completed the study: 21 in the active group and 18 in the control group. Participants were assigned randomly to exercise on a stationary bike in conjunction with anodal tDCS or to exercise combined with a sham tDCS protocol. Walking capacity tests (2-Minute Walk Test, 5-Meter Walk Test, Timed Up and Go test), manual muscle testing, the Fatigue Severity Scale, and the Multiple Sclerosis Quality of Life-54 were used to determine outcomes. RESULTS In terms of observed changes in 2-Minute Walk Test and 5-Meter Walk Test values, the exercise + tDCS group achieved significantly higher posttreatment values than the exercise + sham tDCS group. After the intervention and 1 month later, the intervention group's mean Timed Up and Go test value decreased significantly (P = .002) compared with that of the control group. There was no difference in Fatigue Severity Scale score, Multiple Sclerosis Quality of Life-54 score, or manual muscle testing improvement between the 2 groups. CONCLUSIONS Nonconsecutive sessions of anodal tDCS combined with stationary cycling may have a greater effect on the walking capacity of individuals with MS than exercise alone.
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Affiliation(s)
- Sarvenaz Rahimibarghani
- From the Physical Medicine and Rehabilitation Department (SR, MA, SZE-R, SR-D, HRF), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohaddeseh Azadvari
- From the Physical Medicine and Rehabilitation Department (SR, MA, SZE-R, SR-D, HRF), Tehran University of Medical Sciences, Tehran, Iran
| | - Seyede Zahra Emami-Razavi
- From the Physical Medicine and Rehabilitation Department (SR, MA, SZE-R, SR-D, HRF), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Harirchian
- From the Iranian Center of Neurological Research, Neuroscience Institute (MHH), Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Rahimi-Dehgolan
- From the Physical Medicine and Rehabilitation Department (SR, MA, SZE-R, SR-D, HRF), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid R. Fateh
- From the Physical Medicine and Rehabilitation Department (SR, MA, SZE-R, SR-D, HRF), Tehran University of Medical Sciences, Tehran, Iran
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27
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Ulrichsen KM, Kolskår KK, Richard G, Pedersen ML, Alnaes D, Dørum ES, Sanders AM, Tornås S, Maglanoc LA, Engvig A, Ihle-Hansen H, Nordvik JE, Westlye LT. No add-on effect of tDCS on fatigue and depression in chronic stroke patients: A randomized sham-controlled trial combining tDCS with computerized cognitive training. Brain Behav 2022; 12:e2643. [PMID: 35666655 PMCID: PMC9304833 DOI: 10.1002/brb3.2643] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Fatigue and emotional distress rank high among self-reported unmet needs in life after stroke. Transcranial direct current stimulation (tDCS) may have the potential to alleviate these symptoms for some patients, but the acceptability and effects for chronic stroke survivors need to be explored in randomized controlled trials. METHODS Using a randomized sham-controlled parallel design, we evaluated whether six sessions of 1 mA tDCS (anodal over F3, cathodal over O2) combined with computerized cognitive training reduced self-reported symptoms of fatigue and depression. Among the 74 chronic stroke patients enrolled at baseline, 54 patients completed the intervention. Measures of fatigue and depression were collected at five time points spanning a 2 months period. RESULTS While symptoms of fatigue and depression were reduced during the course of the intervention, Bayesian analyses provided evidence for no added beneficial effect of tDCS. Less severe baseline symptoms were associated with higher performance improvement in select cognitive tasks, and study withdrawal was higher in patients with more fatigue and younger age. Time-resolved symptom analyses by a network approach suggested higher centrality of fatigue items (except item 1 and 2) than depression items. CONCLUSION The results reveal no add-on effect of tDCS on fatigue or depression but support the notion of fatigue as a relevant clinical symptom with possible implications for treatment adherence and response.
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Affiliation(s)
- Kristine M Ulrichsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | - Knut K Kolskår
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | - Geneviève Richard
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mads Lund Pedersen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Dag Alnaes
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Bjørknes College, Oslo, Norway
| | - Erlend S Dørum
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | - Anne-Marthe Sanders
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | | | - Luigi A Maglanoc
- University Center for Information Technology, University of Oslo, Oslo, Norway
| | - Andreas Engvig
- Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway.,Department of Nephrology, Oslo University Hospital, Oslo, Norway
| | | | | | - Lars T Westlye
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Norway
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Pilloni G, Charvet LE, Bikson M, Palekar N, Kim MJ. Potential of Transcranial Direct Current Stimulation in Alzheimer's Disease: Optimizing Trials Toward Clinical Use. J Clin Neurol 2022; 18:391-400. [PMID: 35796264 PMCID: PMC9262447 DOI: 10.3988/jcn.2022.18.4.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a safe and well-tolerated noninvasive method for stimulating the brain that is rapidly developing into a treatment method for various neurological and psychiatric conditions. In particular, there is growing evidence of a therapeutic role for tDCS in ameliorating or delaying the cognitive decline in Alzheimer's disease (AD). We provide a brief overview of the current development and application status of tDCS as a nonpharmacological therapeutic method for AD and mild cognitive impairment (MCI), summarize the levels of evidence, and identify the improvements needed for clinical applications. We also suggest future directions for large-scale controlled clinical trials of tDCS in AD and MCI, and emphasize the necessity of identifying the mechanistic targets to facilitate clinical applications.
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Affiliation(s)
- Giuseppina Pilloni
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Leigh E Charvet
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, City University of New York, NY, USA
| | - Nikhil Palekar
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Min-Jeong Kim
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA.
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29
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Ellwardt E, Muthuraman M, Gonzalez-Escamilla G, Chirumamilla VC, Luessi F, Bittner S, Zipp F, Groppa S, Fleischer V. Network alterations underlying anxiety symptoms in early multiple sclerosis. J Neuroinflammation 2022; 19:119. [PMID: 35610651 PMCID: PMC9131528 DOI: 10.1186/s12974-022-02476-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 05/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety, often seen as comorbidity in multiple sclerosis (MS), is a frequent neuropsychiatric symptom and essentially affects the overall disease burden. Here, we aimed to decipher anxiety-related networks functionally connected to atrophied areas in patients suffering from MS. METHODS Using 3-T MRI, anxiety-related atrophy maps were generated by correlating longitudinal cortical thinning with the severity of anxiety symptoms in MS patients. To determine brain regions functionally connected to these maps, we applied a technique termed "atrophy network mapping". Thereby, the anxiety-related atrophy maps were projected onto a large normative connectome (n = 1000) performing seed-based functional connectivity. Finally, an instructed threat paradigm was conducted with regard to neural excitability and effective connectivity, using transcranial magnetic stimulation combined with high-density electroencephalography. RESULTS Thinning of the left dorsal prefrontal cortex was the only region that was associated with higher anxiety levels. Atrophy network mapping identified functional involvement of bilateral prefrontal cortex as well as amygdala and hippocampus. Structural equation modeling confirmed that the volumes of these brain regions were significant determinants that influence anxiety symptoms in MS. We additionally identified reduced information flow between the prefrontal cortex and the amygdala at rest, and pathologically increased excitability in the prefrontal cortex in MS patients as compared to controls. CONCLUSION Anxiety-related prefrontal cortical atrophy in MS leads to a specific network alteration involving structures that resemble known neurobiological anxiety circuits. These findings elucidate the emergence of anxiety as part of the disease pathology and might ultimately enable targeted treatment approaches modulating brain networks in MS.
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Affiliation(s)
- Erik Ellwardt
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neuroscience (FTN) Neuroimaging Center, Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Gabriel Gonzalez-Escamilla
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Venkata Chaitanya Chirumamilla
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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30
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Ayache SS, Serratrice N, Abi Lahoud GN, Chalah MA. Fatigue in Multiple Sclerosis: A Review of the Exploratory and Therapeutic Potential of Non-Invasive Brain Stimulation. Front Neurol 2022; 13:813965. [PMID: 35572947 PMCID: PMC9101483 DOI: 10.3389/fneur.2022.813965] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Fatigue is the most commonly reported symptom in patients with multiple sclerosis (MS). It is a worrisome, frequent, and debilitating manifestation that could occur at any time during the course of MS and in all its subtypes. It could engender professional, familial, and socioeconomic consequences and could severely compromise the patients' quality of life. Clinically, the symptom exhibits motor, cognitive, and psychosocial facets. It is also important to differentiate between perceived or subjective self-reported fatigue and fatigability which is an objective measure of decrement in the performance of cognitive or motor tasks. The pathophysiology of MS fatigue is complex, and its management remains a challenge, despite the existing body of literature on this matter. Hence, unraveling its neural mechanisms and developing treatment options that target the latter might constitute a promising field to explore. A PubMed/Medline/Scopus search was conducted to perform this review which aims (a) to reappraise the available electrophysiological studies that explored fatigue in patients with MS with a particular focus on corticospinal excitability measures obtained using transcranial magnetic stimulation and (b) to assess the potential utility of employing neuromodulation (i.e., non-invasive brain stimulation techniques) in this context. A special focus will be put on the role of transcranial direct current stimulation and transcranial magnetic stimulation. We have provided some suggestions that will help overcome the current limitations in upcoming research.
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Affiliation(s)
- Samar S. Ayache
- EA4391 Excitabilité Nerveuse and Thérapeutique, Université Paris Est Créteil, Créteil, France
- Department of Clinical Neurophysiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Créteil, France
- *Correspondence: Samar S. Ayache
| | - Nicolas Serratrice
- Department of Spine Surgery, Centre Médico Chirurgical Bizet, Paris, France
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico Chirurgical Bizet, Paris, France
| | - Georges N. Abi Lahoud
- Department of Spine Surgery, Centre Médico Chirurgical Bizet, Paris, France
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico Chirurgical Bizet, Paris, France
| | - Moussa A. Chalah
- EA4391 Excitabilité Nerveuse and Thérapeutique, Université Paris Est Créteil, Créteil, France
- Department of Clinical Neurophysiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Créteil, France
- Moussa A. Chalah
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31
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Tolerability and feasibility of at-home remotely supervised transcranial direct current stimulation (RS-tDCS): Single-center evidence from 6,779 sessions. Brain Stimul 2022; 15:707-716. [DOI: 10.1016/j.brs.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/25/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022] Open
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32
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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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33
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Kan RL, Xu GX, Shu KT, Lai FH, Kranz G, Kranz GS. Effects of non-invasive brain stimulation in multiple sclerosis: systematic review and meta-analysis. Ther Adv Chronic Dis 2022; 13:20406223211069198. [PMID: 35126965 PMCID: PMC8814979 DOI: 10.1177/20406223211069198] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/07/2021] [Indexed: 12/29/2022] Open
Abstract
Objective: The objective of this meta-analysis was to summarize evidence on the therapeutic effects of non-invasive brain stimulation (NIBS) on core symptoms of multiple sclerosis (MS). Specifically, findings from studies deploying transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) protocols were summarized in this review. Methods: We systematically searched articles published in four databases, until 31 May 2021, which compared the effects of active tDCS or rTMS with sham intervention in MS patients. We used a random-effects model for this meta-analysis. Meta-regression and subgroup meta-analysis were used to examine the effects of stimulation dose and different stimulation protocols, respectively. Results: Twenty-five randomized controlled trials (RCTs) were included in this review, consisting of 19 tDCS and 6 rTMS studies. tDCS led to a significant and immediate reduction of fatigue with a large effect size (Hedges’s g = −0.870, 95% confidence intervals (CI) = [−1.225 to −0.458], number needed to treat (NNT) = 2). Particularly, a subgroup analysis showed that applying tDCS over the left DLPFC and bilateral S1 led to fatigue reductions compared to sham stimulation. Furthermore, tDCS had favorable effects on fatigue in MS patients with low physical disability but not those with high physical disability, and additionally improved cognitive function. Finally, whereas rTMS was observed to reduce muscle spasticity, these NIBS protocols showed no further effect on MS-associated pain and mood symptoms. Conclusion: tDCS in MS alleviates fatigue and improves cognitive function whereas rTMS reduces muscle spasticity. More high-quality studies are needed to substantiate the therapeutic effects of different NIBS protocols in MS.
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Affiliation(s)
- Rebecca L.D. Kan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, China
| | - Grace X.J. Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, China
| | - Kate T. Shu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, China
- Department of Rehabilitation, Third Military Medical University Southwest Hospital, Chongqing, China
| | - Frank H.Y. Lai
- Faculty of Health and Life Sciences, The Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Gottfried Kranz
- Neurological Rehabilitation Center Rosenhügel, Vienna, Austria
| | - Georg S. Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, 999077, China; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
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34
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Stampanoni Bassi M, Iezzi E, Centonze D. Multiple sclerosis: Inflammation, autoimmunity and plasticity. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:457-470. [PMID: 35034754 DOI: 10.1016/b978-0-12-819410-2.00024-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In recent years, experimental studies have clarified that immune system influences the functioning of the central nervous system (CNS) in both physiologic and pathologic conditions. The neuro-immune crosstalk plays a crucial role in neuronal development and may be critically involved in mediating CNS response to neuronal damage. Multiple sclerosis (MS) represents a good model to investigate how the immune system regulates neuronal activity. Accordingly, a growing body of evidence has demonstrated that increased levels of pro-inflammatory mediators may significantly impact synaptic mechanisms, influencing overall neuronal excitability and synaptic plasticity expression. In this chapter, we provide an overview of preclinical data and clinical studies exploring synaptic functioning noninvasively with transcranial magnetic stimulation (TMS) in patients with MS. Moreover, we examine how inflammation-driven synaptic dysfunction could affect synaptic plasticity expression, negatively influencing the MS course. Contrasting CSF inflammation together with pharmacologic enhancement of synaptic plasticity and application of noninvasive brain stimulation, alone or in combination with rehabilitative treatments, could improve the clinical compensation and prevent the accumulating deterioration in MS.
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Affiliation(s)
| | - Ennio Iezzi
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Diego Centonze
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy; Laboratory of Synaptic Immunopathology, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
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35
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Chalah MA, Grigorescu C, Kümpfel T, Lefaucheur JP, Padberg F, Palm U, Ayache SS. The effects of transcranial direct current stimulation on sleep in patients with multiple sclerosis-A pilot study. Neurophysiol Clin 2022; 52:28-32. [PMID: 34996695 DOI: 10.1016/j.neucli.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Sleep complaints are commonly reported by patients with multiple sclerosis (PwMS). Several pharmacological and alternative interventions have been tried, but are usually faced by limited efficacy. Hence, exploring other methods such as transcranial direct current stimulation (tDCS), might be of interest. The aim of this study was to assess the effects of bifrontal tDCS on subjective (i.e., Epworth Sleepiness Scale (ESS)) and objective sleep measures (i.e., actigraphy). METHODS Seven patients completed the study. Patients randomly received two blocks of five daily sessions each in a crossover design (active and sham, with a washout interval of three weeks). The anode and cathode were placed over the left and right dorsolateral prefrontal cortices, respectively. Sleep assessment included ESS, sleep onset latency, total sleep duration, time in bed, sleep efficiency, waking after sleep onset, and number of awakenings. RESULTS Compared to baseline scores (11.14 ± 4.06), significant decrease in ESS was obtained after active intervention (7.86 ± 4.18; p = 0.011), but not after sham intervention (9.57 ± 5.62; p = 0.142). No significant changes were observed with regards to actigraphy measures. Sessions were well tolerated, and no serious side-effects were reported at any time. CONCLUSION Bifrontal tDCS resulted in significant improvement in daytime sleepiness, but did not yield any effect on objective sleep measures in PwMS. This discrepency might be explained by the modest association that could exist between objective and subjective sleep measures. In addition, it could be assumed that modulating objective sleep measures would require a larger sample size, more stimulation sessions, or modulation of other cortical areas.
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Affiliation(s)
- Moussa A Chalah
- Univ Paris Est Creteil, Excitabilité Nerveuse et Thérapeutique (ENT), EA 4391, F-94010 Creteil, France; AP-HP, Henri Mondor university hospital, Department of Clinical Neurophysiology, DMU FIxIT, F-94010 Creteil, France
| | - Christina Grigorescu
- Dept. of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Tania Kümpfel
- Institute for Clinical Neuroimmunology, Hospital of the University of Munich, Munich, Germany
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, Excitabilité Nerveuse et Thérapeutique (ENT), EA 4391, F-94010 Creteil, France; AP-HP, Henri Mondor university hospital, Department of Clinical Neurophysiology, DMU FIxIT, F-94010 Creteil, France
| | - Frank Padberg
- Dept. of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ulrich Palm
- Dept. of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Medical Park Chiemseeblick, Bernau, Germany
| | - Samar S Ayache
- Univ Paris Est Creteil, Excitabilité Nerveuse et Thérapeutique (ENT), EA 4391, F-94010 Creteil, France; AP-HP, Henri Mondor university hospital, Department of Clinical Neurophysiology, DMU FIxIT, F-94010 Creteil, France
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36
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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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Rogers A, De Paoli G, Subbarayan S, Copland R, Harwood K, Coyle J, Mitchell L, MacDonald TM, Mackenzie IS. A Systematic Review of Methods used to Conduct Decentralised Clinical Trials. Br J Clin Pharmacol 2021; 88:2843-2862. [PMID: 34961991 PMCID: PMC9306873 DOI: 10.1111/bcp.15205] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/02/2022] Open
Abstract
Aims To evaluate, using quantitative and qualitative approaches, published data on the design and conduct of decentralised clinical trials (DCTs). Methods We searched MEDLINE, EMBASE, CENTRAL, PsycINFO, ProQuest Dissertations and Theses, ClinicalTrials.gov, OpenGrey and Google Scholar for publications reporting, discussing, or evaluating decentralised clinical research methods. Reports of randomised clinical trials using decentralised methods were included in a focused quantitative analysis with a primary outcome of number of randomised participants. All publications discussing or evaluating DCTs were included in a wider qualitative analysis to identify advantages, disadvantages, facilitators, barriers and stakeholder opinions of decentralised clinical trials. Quantitative data were summarised using descriptive statistics, and qualitative data analysed using a thematic approach. Results Initial searches identified 19 704 articles. After removal of duplicates, 18 553 were screened, resulting in 237 eligible for full‐text assessment. Forty‐five trials were included in the quantitative analysis; 117 documents were included in the qualitative analysis. Trials were widely heterogeneous in design and reporting, precluding meta‐analysis of the effect of DCT methods on the primary recruitment outcome. Qualitative analysis formulated 4 broad themes: value, burden, safety and equity. Participant and stakeholder experiences of DCTs were incompletely represented. Conclusion DCTs are developing rapidly. However, there is insufficient evidence to confirm which methods are most effective in trial recruitment, retention, or overall cost. The identified advantages, disadvantages, facilitators and barriers should inform the development of DCT methods. We recommend further research on how DCTs are experienced and perceived by participants and stakeholders to maximise potential benefits.
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Affiliation(s)
- Amy Rogers
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Giorgia De Paoli
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Selvarani Subbarayan
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Rachel Copland
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Kate Harwood
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Joanne Coyle
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Lyn Mitchell
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Thomas M MacDonald
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Isla S Mackenzie
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
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38
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Hiew S, Nguemeni C, Zeller D. Efficacy of transcranial direct current stimulation in people with multiple sclerosis: a review. Eur J Neurol 2021; 29:648-664. [PMID: 34725881 DOI: 10.1111/ene.15163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/27/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) is a chronic inflammatory disease causing a wide range of symptoms including motor and cognitive impairment, fatigue and pain. Over the last two decades, non-invasive brain stimulation, especially transcranial direct current stimulation (tDCS), has increasingly been used to modulate brain function in various physiological and pathological conditions. However, its experimental applications for people with MS were noted only as recently as 2010 and have been growing since then. The efficacy for use in people with MS remains questionable with the results of existing studies being largely conflicting. Hence, the aim of this review is to paint a picture of the current state of tDCS in MS research grounded on studies applying tDCS that have been done to date. METHODS A keyword search was performed to retrieve articles from the earliest article identified until 14 February 2021 using a combination of the groups (1) 'multiple sclerosis', 'MS' and 'encephalomyelitis' and (2) 'tDCS' and 'transcranial direct current stimulation'. RESULTS The analysis of the 30 articles included in this review underlined inconsistent effects of tDCS on the motor symptoms of MS based on small sample sizes. However, tDCS showed promising benefits in ameliorating fatigue, pain and cognitive symptoms. CONCLUSION Transcranial direct current stimulation is attractive as a non-drug approach in ameliorating MS symptoms, where other treatment options remain limited. The development of protocols tailored to the individual's own neuroanatomy using high definition tDCS and the introduction of network mapping in the experimental designs might help to overcome the variability between studies.
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Affiliation(s)
- Shawn Hiew
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Carine Nguemeni
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Daniel Zeller
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
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Cerebellar Contributions to Motor Impairments in People with Multiple Sclerosis. THE CEREBELLUM 2021; 21:1052-1060. [PMID: 34657272 DOI: 10.1007/s12311-021-01336-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 12/25/2022]
Abstract
Although Charcot characterized classic cerebellar symptoms in people with multiple sclerosis (PwMS) in 1877, the impact of cerebellar dysfunction on MS symptoms has predominately been evaluated in the last two decades. Recent studies have clearly demonstrated the association between cerebellar pathology, including atrophy and reduced fractional anisotropy in the peduncles, and motor impairments, such as reduced gait velocity and time to complete walking tasks. However, future studies using novel imaging techniques are needed to elucidate all potential pathophysiology that is associated with disability in PwMS. Additionally, future studies are required to determine the most effective treatments for motor impairments in PwMS, including the specific type and duration of exercise interventions, and potential means to amplify their effects, such as transcranial direct current stimulation (tDCS). This mini-review critically discusses the distinct role of cerebellar dysfunction in motor impairments in PwMS, potential treatments, and directions for future studies.
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Eilam-Stock T, George A, Lustberg M, Wolintz R, Krupp LB, Charvet LE. Telehealth transcranial direct current stimulation for recovery from Post-Acute Sequelae of SARS-CoV-2 (PASC). Brain Stimul 2021; 14:1520-1522. [PMID: 34655835 PMCID: PMC8514329 DOI: 10.1016/j.brs.2021.10.381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tehila Eilam-Stock
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Allan George
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Matthew Lustberg
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Robyn Wolintz
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Lauren B Krupp
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Leigh E Charvet
- Department of Neurology, New York University Langone Health, New York, NY, USA.
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Lerner O, Friedman J, Frenkel-Toledo S. The effect of high-definition transcranial direct current stimulation intensity on motor performance in healthy adults: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:103. [PMID: 34174914 PMCID: PMC8236155 DOI: 10.1186/s12984-021-00899-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/14/2021] [Indexed: 11/22/2022] Open
Abstract
Background The results of transcranial direct current stimulation (tDCS) studies that seek to improve motor performance for people with neurological disorders, by targeting the primary motor cortex, have been inconsistent. One possible reason, among others, for this inconsistency, is that very little is known about the optimal protocols for enhancing motor performance in healthy individuals. The best way to optimize stimulation protocols for enhancing tDCS effects on motor performance by means of current intensity modulation has not yet been determined. We aimed to determine the effect of current intensity on motor performance using–for the first time–a montage optimized for maximal focal stimulation via anodal high-definition tDCS (HD-tDCS) on the right primary motor cortex in healthy subjects. Methods Sixty participants randomly received 20-min HD-tDCS at 1.5, 2 mA, or sham stimulation. Participants’ reaching performance with the left hand on a tablet was tested before, during, and immediately following stimulation, and retested after 24 h. Results In the current montage of HD-tDCS, movement time did not differ between groups in each timepoint. However, only after HD-tDCS at 1.5 mA did movement time improve at posttest as compared to pretest. This reduction in movement time from pretest to posttest was significantly greater compared to HD-tDCS 2 mA. Following HD-tDCS at 1.5 mA and sham HD-tDCS, but not 2 mA, movement time improved at retest compared to pretest, and at posttest and retest compared to the movement time during stimulation. In HD-tDCS at 2 mA, the negligible reduction in movement time from the course of stimulation to posttest was significantly lower compared to sham HD-tDCS. Across all groups, reaction time improved in retest compared to pretest and to the reaction time during stimulation, and did not differ between groups in each timepoint. Conclusions It appears that 2 mA in this particular experimental setup inhibited the learning effects. These results suggest that excitatory effects induced by anodal stimulation do not hold for every stimulation intensity, information that should be taken into consideration when translating tDCS use from the realm of research into more optimal neurorehabilitation. Trial registration: Clinical Trials Gov, NCT04577768. Registered 6 October 2019 -Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000A9B3&selectaction=Edit&uid=U0005AKF&ts=8&cx=buucf0. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00899-z.
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Affiliation(s)
- Ohad Lerner
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Jason Friedman
- Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel. .,Department of Neurological Rehabilitation, Loewenstein Hospital, Raanana, Israel.
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42
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Eilam-Stock T, George A, Charvet LE. Cognitive Telerehabilitation with Transcranial Direct Current Stimulation Improves Cognitive and Emotional Functioning Following a Traumatic Brain Injury: A Case Study. Arch Clin Neuropsychol 2021; 36:442-453. [PMID: 33885138 DOI: 10.1093/arclin/acaa059] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/08/2020] [Accepted: 07/12/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Cognitive deficits following a traumatic brain injury (TBI) are a leading cause of disability in young adults and there is a critical need for novel approaches to improve cognitive outcomes in TBI survivors. Transcranial direct current stimulation (tDCS) paired with cognitive remediation has emerged as a viable, cost-effective, noninvasive approach for treating cognitive impairments in a wide variety of neurological conditions. Here, we report the first case study utilizing remotely supervised tDCS (RS-tDCS) protocol paired with cognitive remediation in a 29-year-old man with persisting cognitive and emotional sequelae following TBI. METHOD Neuropsychological measures were administered before and after the patient completed 20 daily sessions of RS-tDCS (2.0 mA × 20 minutes, left anodal dorsolateral prefrontal cortex montage). During the daily stimulation period, he completed adaptive cognitive training. All treatment procedures were delivered at home and monitored in real time via videoconference with a study technician. RESULTS Following 20 RS-tDCS and cognitive training sessions, he had significant improvements (>1 SD) on tests of attention and working memory, semantic fluency, and information processing speed. Mood was also improved. CONCLUSIONS This is the first demonstration of at-home telerehabilitation with RS-tDCS and cognitive training to improve cognitive outcomes following TBI.
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Affiliation(s)
- Tehila Eilam-Stock
- Department of Neurology, NYU Grossman School of Medicine, New York 10017, USA
| | - Allan George
- Department of Neurology, NYU Grossman School of Medicine, New York 10017, USA
| | - Leigh E Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York 10017, USA
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43
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Objective electrophysiological fatigability markers and their modulation through tDCS. Clin Neurophysiol 2021; 132:1721-1732. [PMID: 33867262 DOI: 10.1016/j.clinph.2021.02.391] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Cognitive fatigability is a frequent symptom after sustained performance. Fatigability is evident in healthy subjects but is also often comorbid in several neuropsychiatric diseases. However, to date, clinical diagnostic almost solely relies on the self-reported subjective experience of fatigue. The goals of this present study were i) to complement the purely subjective fatigue diagnostic with objective electrophysiological fatigability parameters and ii) to prove the potential therapeutic application of transcranial direct current stimulation (tDCS) as a fatigability intervention. METHODS We performed a pseudo-randomized, sham-controlled, parallel-group trial. Forty healthy participants received either anodal or sham tDCS over the left dorsolateral prefrontal cortex (DLPFC) while they performed an exhaustive cognitive task to induce cognitive fatigability. To assess fatigability changes, we analyzed variations of prepulse inhibition (PPI) and P50 suppression as well as frontomedial theta and occipital alpha power with time-on-task. RESULTS The task reliably induced subjective exhaustion in all participants. Furthermore, we confirmed fatigability-related increases in frontomedial theta and occipital alpha power throughout the task. Additionally, fatigability significantly reduced PPI as well as P50 sensory gating. Anodal tDCS over the left DLPFC successfully counteracted fatigability and reduced the fatigability-related increase in alpha power as well as the decline in both gating parameters. CONCLUSION Occipital alpha and sensorimotor/sensory gating are suitable parameters to assess the severity of fatigability objectively. Anodal tDCS can counteract fatigability and has therapeutic potential for the treatment of fatigability in neuropsychiatric diseases. SIGNIFICANCE Fatigability can be objectively assessed by electrophysiological measures and attenuated by tDCS.
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Hsu WY, Cheng CH, Zanto TP, Gazzaley A, Bove RM. Effects of Transcranial Direct Current Stimulation on Cognition, Mood, Pain, and Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:626113. [PMID: 33763014 PMCID: PMC7982804 DOI: 10.3389/fneur.2021.626113] [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] [Received: 11/04/2020] [Accepted: 02/10/2021] [Indexed: 12/29/2022] Open
Abstract
Background: The study aimed to evaluate the effects of transcranial direct current stimulation (tDCS) on cognition, mood disturbance, pain, and fatigue in people with multiple sclerosis (PwMS). Methods: A literature search was performed on articles published between January 1990 and May 2020 in Pubmed, Medline, and Web of Science using the following keywords and their abbreviation in combinations: multiple sclerosis and transcranial direct current stimulation. Mean effect size (ES) and 95% confidence interval were calculated for each domain of interest. Results: Seventeen articles with a total of 383 PwMS were included in this analysis. For cognition, a strong effect size was found for the trial administering the Symbol Digit Modalities Test (ES: 1.15), whereas trials applying the Attention Network Test showed a negative effect size of −0.49. Moderate to strong effect sizes were observed for mood disturbance (mean ES: 0.92), pain (mean ES: 0.59), and fatigue (mean ES: 0.60). Further subgroup analyses for MS-related fatigue showed that both high and low intensities of stimulation lead to nearly the same degree of favorable effects. More pronounced effects were observed in studies administering the Fatigue Severity Scale compared with studies using other fatigue measures such as the Modified Fatigue Impact Scale. Conclusion: These results provide preliminary evidence that tDCS has a favorable effect on cognitive processing speed, mood disturbance, pain, and fatigue in MS. However, the effects on cognition and fatigue vary based on the specific assessment used.
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Affiliation(s)
- Wan-Yu Hsu
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Chia-Hsiung Cheng
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Theodore P Zanto
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Neuroscape, University of California, San Francisco, San Francisco, CA, United States
| | - Adam Gazzaley
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Neuroscape, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.,Department of Physiology, University of California, San Francisco, San Francisco, CA, United States
| | - Riley M Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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45
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Effect of transcranial direct current stimulation on post-stroke fatigue. J Neurol 2021; 268:2831-2842. [PMID: 33598767 PMCID: PMC8289762 DOI: 10.1007/s00415-021-10442-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/03/2023]
Abstract
Background Fatigue is one of the most commonly reported symptoms post-stroke, which has a severe impact on the quality of life. Post-stroke fatigue is associated with reduced motor cortical excitability, specifically of the affected hemisphere. Objective The aim of this exploratory study was to assess whether fatigue symptoms can be reduced by increasing cortical excitability using anodal transcranial direct current stimulation (tDCS). Methods In this sham-controlled, double-blind intervention study, tDCS was applied bilaterally over the primary motor cortex in a single session in thirty stroke survivors with high severity of fatigue. A questionnaire-based measure of trait fatigue (primary outcome) was obtained before, after a week and 5 weeks post stimulation. Secondary outcome measures of state fatigue, motor cortex neurophysiology and perceived effort were also assessed pre, immediately post, a week and 5 weeks post stimulation. Results Anodal tDCS significantly improved fatigue symptoms a week after real stimulation when compared to sham stimulation. There was also a significant change in motor cortex neurophysiology of the affected hemisphere and perceived effort, a week after stimulation. The degree of improvement in fatigue was associated with baseline anxiety levels. Conclusion A single session of anodal tDCS improves fatigue symptoms with the effect lasting up to a week post stimulation. tDCS may therefore be a useful tool for managing fatigue symptoms post-stroke. Trial registration NCT04634864 Date of registration 17/11/2020–“retrospectively registered”.
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Pinto ACPN, Piva SR, Vieira AGDS, Gomes SGCN, Rocha AP, Tavares DRB, Santana MVDA, Carlesso C, Andriolo A, Santos FC, Fregni F, Trevisani VFM. Transcranial direct current stimulation for fatigue in patients with Sjogren's syndrome: A randomized, double-blind pilot study. Brain Stimul 2020; 14:141-151. [PMID: 33340767 DOI: 10.1016/j.brs.2020.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/16/2020] [Accepted: 12/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Transcranial direct-current stimulation (tDCS) has shown promise to decrease fatigue. However, it has never been examined in primary Sjogren Syndrome (pSS). OBJECTIVE To assess the effect of a tDCS protocol on fatigue in patients with pSS. METHODS This is a parallel, double-blind pilot study (NCT04119128). Women aged 18-65 years, with pSS, on stable pharmacological therapy, with complaints of fatigue for at least three months, and with scores >5 on Fatigue Severity Scale (FSS) were included. We randomized 36 participants to receive five consecutive or sham tDCS sessions, with an intensity of 2 mA, for 20 min/day. RESULTS After five tDCS sessions, fatigue severity assessed by the FSS (primary outcome) demonstrated a mean group difference of -0.85 [95% confidence interval (CI) -1.57, -0.13; effect size 0.80] favouring the active group. The active group presented significantly greater reductions in fatigue as measured by the EULAR Sjögren's Syndrome Patient Reported Index after five tDCS sessions [mean group difference: 1.40; 95%CI -2.33, -0.48; effect size 1.04]. Although there were no between-group differences in the secondary outcomes of sleep, mood and anxiety, within-group comparisons evidenced a small but significant difference in the active group for pain and sleep. There were no significant cortisol changes. All reported adverse events were mild and transitory. CONCLUSION tDCS seems to be safe and reduce fatigue in pSS. A differential effect on pain and sleep may underlie its effects. Further studies are needed to optimise tDCS treatment strategies in pSS.
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Affiliation(s)
- Ana Carolina Pereira Nunes Pinto
- Evidence-Based Health Program, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Fulbright Scholar at University of Pittsburgh, PA, USA; Biological and Health Sciences Department, Universidade Federal Do Amapa (UNIFAP), AP, Brazil
| | - Sara Regina Piva
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh. Pittsburgh, PA, USA.
| | | | | | | | | | | | - Cristiane Carlesso
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh. Pittsburgh, PA, USA
| | | | | | - Felipe Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
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Pilloni G, Bikson M, Badran BW, George MS, Kautz SA, Okano AH, Baptista AF, Charvet LE. Update on the Use of Transcranial Electrical Brain Stimulation to Manage Acute and Chronic COVID-19 Symptoms. Front Hum Neurosci 2020; 14:595567. [PMID: 33281589 PMCID: PMC7689057 DOI: 10.3389/fnhum.2020.595567] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022] Open
Abstract
The coronavirus disease 19 (COVID-19) pandemic has resulted in the urgent need to develop and deploy treatment approaches that can minimize mortality and morbidity. As infection, resulting illness, and the often prolonged recovery period continue to be characterized, therapeutic roles for transcranial electrical stimulation (tES) have emerged as promising non-pharmacological interventions. tES techniques have established therapeutic potential for managing a range of conditions relevant to COVID-19 illness and recovery, and may further be relevant for the general management of increased mental health problems during this time. Furthermore, these tES techniques can be inexpensive, portable, and allow for trained self-administration. Here, we summarize the rationale for using tES techniques, specifically transcranial Direct Current Stimulation (tDCS), across the COVID-19 clinical course, and index ongoing efforts to evaluate the inclusion of tES optimal clinical care.
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Affiliation(s)
- Giuseppina Pilloni
- Department of Neurology, NYU Langone Health, New York, NY, United States
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
| | - Bashar W. Badran
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Mark S. George
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
- Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, United States
| | - Steven A. Kautz
- Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, United States
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, United States
| | - Alexandre Hideki Okano
- Center for Mathematics, Computation and Cognition, Universidade Federal do ABC, São Bernardo do Campo, Brazil
- Brazilian Institute of Neuroscience and Neurothechnology 52 (BRAINN/CEPID53 FAPESP), University of Campinas, Campinas, Brazil
| | - Abrahão Fontes Baptista
- Center for Mathematics, Computation and Cognition, Universidade Federal do ABC, São Bernardo do Campo, Brazil
- Brazilian Institute of Neuroscience and Neurothechnology 52 (BRAINN/CEPID53 FAPESP), University of Campinas, Campinas, Brazil
- Laboratory of Medical Investigation 54 (LIM-54), São Paulo University, São Paulo, Brazil
| | - Leigh E. Charvet
- Department of Neurology, NYU Langone Health, New York, NY, United States
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Vannorsdall TD, Straub E, Saba C, Blackwood M, Zhang J, Stearns K, Smith KL. Interventions for multidimensional aspects of breast cancer-related fatigue: a meta-analytic review. Support Care Cancer 2020; 29:1753-1764. [DOI: 10.1007/s00520-020-05752-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022]
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Pilloni G, Choi C, Shaw MT, Coghe G, Krupp L, Moffat M, Cocco E, Pau M, Charvet L. Walking in multiple sclerosis improves with tDCS: a randomized, double-blind, sham-controlled study. Ann Clin Transl Neurol 2020; 7:2310-2319. [PMID: 33080122 PMCID: PMC7664269 DOI: 10.1002/acn3.51224] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/21/2020] [Accepted: 09/27/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate whether multiple sessions of transcranial direct current stimulation (tDCS) applied to the primary motor (M1) cortex paired with aerobic exercise can improve walking functions in multiple sclerosis (MS). METHODS MS participants were recruited for a double-blind, parallel-arm, randomized, sham-controlled trial and assigned to 10 sessions (5 d/wk for 2 weeks) of either active or sham tDCS paired with unloaded cycling for 20 minutes. Stimulation was administered over the left M1 cortex (2.5 mA; anode over C3/cathode over FP2). Gait spatiotemporal parameters were assessed using a wearable inertial sensor (10-meter and 2-minute walking tests). Measurements were collected at baseline, end of tDCS intervention, and 4-week postintervention to test for duration of any benefits. RESULTS A total of 15 participants completed the study, nine in the active and six in the sham condition. The active and sham groups were matched according to gender (50% vs. 40% female), neurologic disability (median EDSS 5.5 vs. 5), and age (mean 52.1 ± 12.9 vs. 53.7 ± 9.8 years). The active group had a significantly greater increase in gait speed (0.87 vs. 1.20 m/s, p < 0.001) and distance covered during the 2-minute walking test (118.53 vs. 133.06 m, p < 0.001) at intervention end compared to baseline. At 4-week follow-up, these improvements were maintained (baseline vs. follow-up: gait speed 0.87 vs. 1.18 m/s, p < 0.001; distance traveled 118.53 vs. 143.82 m, p < 0.001). INTERPRETATION Multiple sessions of tDCS paired with aerobic exercise lead to cumulative and persisting improvements in walking and endurance in patients with MS.
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Affiliation(s)
- Giuseppina Pilloni
- Department of Neurology, NYU Langone Health, New York, NY, USA.,Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Claire Choi
- Department of Medicine, SUNY Downstate, New York, NY, USA
| | - Michael T Shaw
- Department of Psychology, Binghamton University, New York, NY, USA
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Lauren Krupp
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Marilyn Moffat
- Department of Physical Therapy, New York University, New York, NY, USA
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Leigh Charvet
- Department of Neurology, NYU Langone Health, New York, NY, USA
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Shaw M, Pilloni G, Charvet L. Delivering Transcranial Direct Current Stimulation Away From Clinic: Remotely Supervised tDCS. Mil Med 2020; 185:319-325. [PMID: 32074357 DOI: 10.1093/milmed/usz348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION To demonstrate the broad utility of the remotely supervised transcranial direct current stimulation (RS-tDCS) protocol developed to deliver at-home rehabilitation for individuals with multiple sclerosis (MS). METHODS Stimulation delivered with the RS-tDCS protocol and paired with adaptive cognitive training was delivered to three different study groups of MS patients to determine the feasibility and tolerability of the protocol. The three studies each used consecutively increasing amounts of stimulation amperage (1.5, 2.0, and 2.5 mA, respectively) and session numbers (10, 20, and 40 sessions, respectively). RESULTS High feasibility and tolerability of the stimulation were observed for n = 99 participants across three tDCS pilot studies. CONCLUSIONS RS-tDCS is feasible and tolerable for MS participants. The RS-tDCS protocol can be used to reach those in locations without clinic access and be paired with training or rehabilitation in locations away from the clinic. This protocol could be used to deliver tDCS paired with training or rehabilitation activities remotely to service members and veterans.
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Affiliation(s)
- Michael Shaw
- New York University Langone Health, 222 E 41st Street New York, NY 10017
| | - Giuseppina Pilloni
- New York University Langone Health, 222 E 41st Street New York, NY 10017.,Department of Mechanical Chemical and Materials Engineering, University of Cagliari, Via Marengo 2, Cagliari, ITALY 09123
| | - Leigh Charvet
- New York University Langone Health, 222 E 41st Street New York, NY 10017
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