Facilitated Event-Related Power Modulations during Transcranial Alternating Current Stimulation (tACS) Revealed by Concurrent tACS-MEG

Transcranial temporal interference stimulation (tTIS) influences event-related alpha activity during mental rotation

Non-invasive brain stimulation techniques offer therapeutic potential for neurological and psychiatric disorders. However, current methods are often limited in their stimulation depth. The novel transcranial temporal interference stimulation (tTIS) aims to overcome this limitation by non-invasively targeting deeper brain regions. In this study, we aimed to evaluate the efficacy of tTIS in modulating alpha activity during a mental rotation task. The effects of tTIS were compared with transcranial alternating current stimulation (tACS) and a sham control. Participants were randomly assigned to a tTIS, tACS, or sham group. They performed alternating blocks of resting and mental rotation tasks before, during, and after stimulation. During the stimulation blocks, participants received 20 min of stimulation adjusted to their individual alpha frequency (IAF). We assessed shifts in resting state alpha power, event-related desynchronization (ERD) of alpha activity during mental rotation, as well as resulting improvements in behavioral performance. Our results indicate tTIS and tACS to be effective in modulating cortical alpha activity during mental rotation, leading to an increase in ERD from pre- to poststimulation as well as compared to sham stimulation. However, this increase in ERD was not correlated with enhanced mental rotation performance, and resting state alpha power remained unchanged. Our findings underscore the complex nature of tTIS and tACS efficacy, indicating that stimulation effects are more observable during active cognitive tasks, while their impacts are less pronounced on resting neuronal systems.

The effect of transcranial electrical stimulation on the relief of mental fatigue

Objective

The presence of mental fatigue seriously affects daily life and working conditions. Non-invasive transcranial electrical stimulation has become an increasingly popular tool for relieving mental fatigue. We investigated whether transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) could be used to alleviate the state of mental fatigue in a population of healthy young adults and compared their effects.

Methods

We recruited 10 participants for a blank control, repeated measures study. Each participant received 15 min of anodal tDCS, α-tACS, and blank stimulation. Participants were required to fill in the scale, perform the test task and collect ECG signals in the baseline, fatigue and post-stimulus states. We then assessed participants' subjective fatigue scale scores, test task accuracy and HRV characteristics of ECG signals separately.

Results

We found that both anodal tDCS and α-tACS significantly (P < 0.05) reduced subjective fatigue and improved accuracy on the test task compared to the blank group, and the extent of change was greater with tACS. For the HRV features extracted from ECG signals. After tACS intervention, SDNN (t = -3.241, P = 0.002), LF (t = -3.511, P = 0.001), LFn (t = -3.122, P = 0.002), LFn/HFn (-2.928, P = 0.005), TP (t = -2.706, P = 0.008), VLF (t = -3.002, P = 0.004), SD2 (t = -3.594, P = 0.001) and VLI (t = -3.564, P = 0.001) showed a significant increasing trend, and HFn (t = 3.122, P = 0.002), SD1/SD2 (t = 3.158, P = 0.002) and CCM_1 (t = 3.106, P = 0.003) showed a significant decreasing trend. After tDCS intervention, only one feature, TINN, showed a significant upward trend (P < 0.05). The other features showed non-significant changes but roughly the same trend as the tACS group.

Conclusion

Both tDCS and α-tACS can be effective in relieving mental fatigue, and α-tACS is more effective than tDCS. This study provides theoretical support for tDCS with α-tACS having a alleviating effect on mental fatigue and the use of ECG as a valid objective assessment tool.

Advances in Non-Invasive Neuromodulation Techniques for Improving Cognitive Function: A Review

Non-invasive neuromodulation techniques are widely utilized to study and improve cognitive function, with the aim of modulating different cognitive processes. For workers performing high-intensity mental and physical tasks, extreme fatigue may not only affect their working efficiency but may also lead to cognitive decline or cognitive impairment, which, in turn, poses a serious threat to their physical health. The use of non-invasive neuromodulation techniques has important research value for improving and enhancing cognitive function. In this paper, we review the research status, existing problems, and future prospects of transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial magnetic stimulation (TMS), and transcutaneous acupoint stimulation (TAS), which are the most studied physical methods in non-invasive neuromodulation techniques to improve and enhance cognition. The findings presented in this paper will be of great reference value for the in-depth study of non-invasive neuromodulation techniques in the field of cognition.

The effect of a cognitive training therapy based on stimulation of brain oscillations in patients with mild cognitive impairment in a Chilean sample: study protocol for a phase IIb, 2 × 3 mixed factorial, double-blind randomised controlled trial

BACKGROUND

The ageing population has increased the prevalence of disabling and high-cost diseases, such as dementia and mild cognitive impairment (MCI). The latter can be considered a prodromal phase of some dementias and a critical stage for interventions to postpone the impairment of functionality. Working memory (WM) is a pivotal cognitive function, representing the fundamental element of executive functions. This project proposes an intervention protocol to enhance WM in these users, combining cognitive training with transcranial electrical stimulation of alternating current (tACS). This technique has been suggested to enhance the neuronal plasticity needed for cognitive processes involving oscillatory patterns. WM stands to benefit significantly from this approach, given its well-defined electrophysiological oscillations. Therefore, tACS could potentially boost WM in patients with neurodegenerative diseases.

METHODS

This study is a phase IIb randomised, double-blind clinical trial with a 3-month follow-up period. The study participants will be 62 participants diagnosed with MCI, aged over 60, from Valparaíso, Chile. Participants will receive an intervention combining twelve cognitive training sessions with tACS. Participants will receive either tACS or placebo stimulation in eight out of twelve training sessions. Sessions will occur twice weekly over 6 weeks. The primary outcomes will be electroencephalographic measurements through the prefrontal theta oscillatory activity, while the secondary effects will be cognitive assessments of WM. The participants will be evaluated before, immediately after, and 3 months after the end of the intervention.

DISCUSSION

The outcomes of this trial will add empirical evidence about the benefits and feasibility of an intervention that combines cognitive training with non-invasive brain stimulation. The objective is to contribute tools for optimal cognitive treatment in patients with MCI. To enhance WM capacity, postpone the impairment of functionality, and obtain a better quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05291208. Registered on 28 February 2022. ISRCTN87597719 retrospectively registered on 15 September 2023.

Does 20 Hz Transcranial Alternating Current Stimulation over the Human Primary Motor Cortex Modulate Beta Rebound Following Voluntary Movement?

Beta frequency oscillations originating from the primary motor cortex increase in amplitude following the initiation of voluntary movement, a process termed beta rebound. The strength of beta rebound has been reported to predict the recovery of motor function following stroke, suggesting therapeutic applications of beta rebound modulation. The present study examined the effect of 20 Hz transcranial alternating current stimulation (tACS) on the beta rebound induced by self-paced voluntary movement. Electroencephalograms (EEGs) and electromyograms (EMGs) were recorded from 16 healthy adults during voluntary movements performed before and after active or sham tACS. There was no significant change in average beta rebound after active tACS. However, the beta rebound amplitude was significantly enhanced in a subset of participants, and the magnitude of the increase across all participants was negatively correlated with the difference between individual peak beta frequency and tACS frequency. Thus, matching the stimulus frequency of tACS with individual beta frequency may facilitate therapeutic enhancement for motor rehabilitation.

A meta-analysis showing improved cognitive performance in healthy young adults with transcranial alternating current stimulation

Transcranial alternating current stimulation (tACS) is a non-invasive brain stimulation used for improving cognitive functions via delivering weak electrical stimulation with a certain frequency. This systematic review and meta-analysis investigated the effects of tACS protocols on cognitive functions in healthy young adults. We identified 56 qualified studies that compared cognitive functions between tACS and sham control groups, as indicated by cognitive performances and cognition-related reaction time. Moderator variable analyses specified effect size according to (a) timing of tACS, (b) frequency band of simulation, (c) targeted brain region, and (b) cognitive domain, respectively. Random-effects model meta-analysis revealed small positive effects of tACS protocols on cognitive performances. The moderator variable analyses found significant effects for online-tACS with theta frequency band, online-tACS with gamma frequency band, and offline-tACS with theta frequency band. Moreover, cognitive performances were improved in online- and offline-tACS with theta frequency band on either prefrontal and posterior parietal cortical regions, and further both online- and offline-tACS with theta frequency band enhanced executive function. Online-tACS with gamma frequency band on posterior parietal cortex was effective for improving cognitive performances, and the cognitive improvements appeared in executive function and perceptual-motor function. These findings suggested that tACS protocols with specific timing and frequency band may effectively improve cognitive performances.

The hidden brain-state dynamics of tACS aftereffects

Non-invasive techniques to electrically stimulate the brain such as transcranial direct and alternating current stimulation (tDCS/tACS) are increasingly used in human neuroscience and offer potential new avenues to treat brain disorders. Previous research has shown that stimulation effects may depend on brain-states. However, this work mostly focused on experimentally induced brain-states over the course of several minutes. Besides such global, long-term changes in brain-states, previous research suggests, that the brain is likely to spontaneously alternate between states in sub-second ranges, which is much closer to the time scale at which it is generally believed to operate. Here, we utilized Hidden Markov Models (HMM) to decompose magnetoencephalography data obtained before and after tACS into spontaneous, transient brain-states with distinct spatial, spectral and connectivity profiles. Only one out of four spontaneous brain-states, likely reflecting default mode network activity, showed evidence for an effect of tACS on the power of spontaneous α-oscillations. The identified state appears to disproportionally drive the overall (non-state resolved) tACS effect. No or only marginal effects were found in the remaining states. We found no evidence that tACS influenced the time spent in each state. Although stimulation was applied continuously, our results indicate that spontaneous brain-states and their underlying functional networks differ in their susceptibility to tACS. Global stimulation aftereffects may be disproportionally driven by distinct time periods during which the susceptible state is active. Our results may pave the ground for future work to understand which features make a specific brain-state susceptible to electrical stimulation.

The left inferior frontal gyrus is causally linked to vocal feedback control: evidence from high-definition transcranial alternating current stimulation

Current models of speech motor control propose a role for the left inferior frontal gyrus (IFG) in feedforward control of speech production. There is evidence, however, that has implicated the functional relevance of the left IFG for the neuromotor processing of vocal feedback errors. The present event-related potential (ERP) study examined whether the left IFG is causally linked to auditory feedback control of vocal production with high-definition transcranial alternating current stimulation (HD-tACS). After receiving active or sham HD-tACS over the left IFG at 6 or 70 Hz, 20 healthy adults vocalized the vowel sounds while hearing their voice unexpectedly pitch-shifted by ±200 cents. The results showed that 6 or 70 Hz HD-tACS over the left IFG led to larger magnitudes and longer latencies of vocal compensations for pitch perturbations paralleled by larger ERP P2 responses than sham HD-tACS. Moreover, there was a lack of frequency specificity that showed no significant differences between 6 and 70 Hz HD-tACS. These findings provide first causal evidence linking the left IFG to vocal pitch regulation, suggesting that the left IFG is an important part of the feedback control network that mediates vocal compensations for auditory feedback errors.

Removal of Transcranial Alternating Current Stimulation EEG Artifacts Using Blind Source Separation and Wavelets

GOAL

Transcranial alternating current stimulation (tACS) is a non-invasive technology for modulating brain activity, with significant potential for improving motor and cognitive functions. To investigate the effects of tACS, many studies have used electroencephalographic (EEG) data recorded during brain stimulation. However, the large artifacts induced by tACS make the analysis of tACS-EEG recordings challenging, which in turn has prevented the implementation of closed-loop brain stimulation schemes. Here, we propose a novel combination of blind source separation (BSS) and wavelets to achieve removal of tACS-EEG artifacts with improved performance.

METHODS

We examined the performance of several BSS methods both applied individually, as well as combined with the empirical wavelet transform (EWT) in terms of denoising realistic simulated and experimental tACS-EEG data.

RESULTS

EWT combined with BSS yielded considerably improved performance compared to BSS alone for both simulated and experimental data. Overall, independent vector analysis (IVA) combined with EWT yielded the best performance.

SIGNIFICANCE

The proposed method yields promise for quantifying the effects of tACS on simultaneously recorded EEG data, which can in turn contribute towards understanding the effects of tACS on brain activity, as well as extracting reliable biomarkers that may be used to develop closed-loop tACS strategies for modulating the underlying brain activity in real time.

Non-invasive brain stimulation in modulation of mental rotation ability: A systematic review and meta-analysis

Mental rotation, the ability to manipulate mental images, is an important function in human cognition. This systematic review and meta-analysis investigates the potential of non-invasive brain stimulation in modulation of this component of visuo-spatial perception. The PubMed database was reviewed prior to 31 September 2020 on randomized controlled trials investigating the effects of repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and transcranial alternating current stimulation (tACS) on the mental rotation ability in healthy persons. A total of 17 studies (including 485 subjects) matched our inclusion criteria. Within their scope, overall, 46 sham-controlled experiments were performed. Methodology and results of each experiment are presented in a meta-analysis. The data show a large variety of methods and effects. The influence of (1) stimulation-technique (tDCS, tACS, and rTMS), (2) stimulation protocol (anodal, cathodal, bilateral tDCS, tACS, high-frequency rTMS, low-frequency rTMS, paired pulse rTMS, and theta burst stimulation), (3) stimulation timing (preconditioning and simultaneous), (4) stimulation location (left, right hemisphere, frontal, and parietal area), and (5) stimulus type (bodily and non-bodily) is discussed. The data indicate a beneficial effect of anodal tDCS and of tACS and no effect of cathodal tDCS on the mental rotation ability. Bilateral tDCS protocols both improved and worsened the parameters assessed. The small effect sizes obtained in mostly rTMS experiments require cautious interpretation.

Effects of Transcranial Alternating Current Stimulation and Neurofeedback on Alpha (EEG) Dynamics: A Review

Transcranial alternating current stimulation (tACS) and neurofeedback (NFB) are two different types of non-invasive neuromodulation techniques, which can modulate brain activity and improve brain functioning. In this review, we compared the current state of knowledge related to the mechanisms of tACS and NFB and their effects on electroencephalogram (EEG) activity (online period/stimulation period) and on aftereffects (offline period/post/stimulation period), including the duration of their persistence and potential behavioral benefits. Since alpha bandwidth has been broadly studied in NFB and in tACS research, the studies of NFB and tACS in modulating alpha bandwidth were selected for comparing the online and offline effects of these two neuromodulation techniques. The factors responsible for variability in the responsiveness of the modulated EEG activity by tACS and NFB were analyzed and compared too. Based on the current literature related to tACS and NFB, it can be concluded that tACS and NFB differ a lot in the mechanisms responsible for their effects on an online EEG activity but they possibly share the common universal mechanisms responsible for the induction of aftereffects in the targeted stimulated EEG band, namely Hebbian and homeostatic plasticity. Many studies of both neuromodulation techniques report the aftereffects connected to the behavioral benefits. The duration of persistence of aftereffects for NFB and tACS is comparable. In relation to the factors influencing responsiveness to tACS and NFB, significantly more types of factors were analyzed in the NFB studies compared to the tACS studies. Several common factors for both tACS and NFB have been already investigated. Based on these outcomes, we propose several new research directions regarding tACS and NFB.

A Comparison of Closed Loop vs. Fixed Frequency tACS on Modulating Brain Oscillations and Visual Detection

Transcranial alternating current stimulation has emerged as an effective tool for the exploration of brain oscillations. By applying a weak alternating current between electrodes placed on the scalp matched to the endogenous frequency, tACS enables the specific modulation of targeted brain oscillations This results in alterations in cognitive functions or persistent physiological changes. Most studies that utilize tACS determine a fixed stimulation frequency prior to the stimulation that is kept constant throughout the experiment. Yet it is known that brain rhythms can encounter shifts in their endogenous frequency. This could potentially move the ongoing brain oscillations into a frequency region where it is no longer affected by the stimulation, thereby decreasing or negating the effect of tACS. Such an effect of a mismatch between stimulation frequency and endogenous frequency on the outcome of stimulation has been shown before for the parietal alpha-activity. In this study, we employed an intermittent closed loop stimulation protocol, where the stimulation is divided into short epochs, between which an EEG is recorded and rapidly analyzed to determine a new stimulation frequency for the next stimulation epoch. This stimulation protocol was tested in a three-group study against a classical fixed stimulation protocol and a sham-treatment. We targeted the parietal alpha rhythm and hypothesized that this setup will ensure a constant close match between the frequencies of tACS and alpha activity. This closer match should lead to an increased modulation of detection of visual luminance changes depending on the phase of the tACS and an increased rise in alpha peak power post stimulation when compared to a protocol with fixed pre-determined stimulation frequency. Contrary to our hypothesis, our results show that only a fixed stimulation protocol leads to a persistent increase in post-stimulation alpha power as compared to sham. Furthermore, in none of the stimulated groups significant modulation of detection performance occurred. While the lack of behavioral effects is inconclusive due to the short selection of different phase bins and trials, the physiological results suggest that a constant stimulation with a fixed frequency is actually beneficial, when the goal is to produce persistent synaptic changes.

The effect of somatosensory alpha transcranial alternating current stimulation on pain empathy is trait empathy and gender dependent

Background

Pain empathy enables a person to experience and understand other's pain state by observing others in pain condition. Such prosocial ability is deficient in many psychopathological disorders. Somatosensory alpha suppression is considered as neural correlates of pain empathy and is hypothesized as a target for enhancement of pain empathy. Researches demonstrated that alpha suppression could be enhanced by transcranial alternating current stimulation (tACS) at alpha frequency non‐invasively.

Aims

We applied alpha tACS over the primary somatosensory cortex of healthy subjects to investigate whether alpha tACS is able to enhance the pain empathy performance.

Results

The results showed that there was no difference of pain empathy performance between alpha tACS and sham tACS either when tACS was applied during the task or before task. While in the alpha tACS group, the pain empathy performance was positively correlated with empathic concern of male subjects, the sub‐component of personal trait empathy.

Conclusions

Alpha tACS cannot alter the empathy performance overall, but the modulation effect of alpha tACS on pain empathy is dependent on the gender and trait empathy of subjects.

Online and offline effects of transcranial alternating current stimulation of the primary motor cortex

Transcranial alternating current stimulation (tACS) is a non-invasive brain stimulation technique that allows interaction with endogenous cortical oscillatory rhythms by means of external sinusoidal potentials. The physiological mechanisms underlying tACS effects are still under debate. Whereas online (e.g., ongoing) tACS over the motor cortex induces robust state-, phase- and frequency-dependent effects on cortical excitability, the offline effects (i.e. after-effects) of tACS are less clear. Here, we explored online and offline effects of tACS in two single-blind, sham-controlled experiments. In both experiments we used neuronavigated transcranial magnetic stimulation (TMS) of the primary motor cortex (M1) as a probe to index changes of cortical excitability and delivered M1 tACS at 10 Hz (alpha), 20 Hz (beta) and sham (30 s of low-frequency transcranial random noise stimulation; tRNS). Corticospinal excitability was measured by single pulse TMS-induced motor evoked potentials (MEPs). tACS was delivered online in Experiment 1 and offline in Experiment 2. In Experiment 1, the increase of MEPs size was maximal with the 20 Hz stimulation, however in Experiment 2 neither the 10 Hz nor the 20 Hz stimulation induced tACS offline effects. These findings support the idea that tACS affects cortical excitability only during online application, at least when delivered on the scalp overlying M1, thereby contributing to the development of effective protocols that can be applied to clinical populations.

Potential targets for the treatment of ADHD using transcranial electrical current stimulation

Attention deficit hyperactivity disorder (ADHD) is a psychiatric disease with a prevalence of 2%-7.5% among the population. It is characterized by three core symptoms: hyperactivity, impulsivity, and inattention. Although the majority of ADHD patients respond to a combination of psychotherapy and standard pharmacotherapy with Methylphenidate, there is a significant minority of patients that do not respond to these substances. Additionally, the treatment with Methylphenidate can cause a variety of side effects like insomnia, headache, decreased appetite, and xerostomia. It would be favorable to have an alternative treatment-option that could circumnavigate the shortcomings of traditional pharmacological treatments. Recent results show that transcranial electrical stimulation (tES) might offer a promising approach. Since research has shown that ADHD is associated with various alterations in brain activity, brain stimulation methods targeting different facets of neuronal functions are currently under investigation. In this article, we briefly review different tES techniques like transcranial random noise stimulation (tRNS), transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) and explain the modes of action of these brain stimulations. We will specifically focus on transcranial alternating current stimulation (tACS) as a potential method of treating ADHD.

Signal-Space Projection Suppresses the tACS Artifact in EEG Recordings

Background

To probe the functional role of brain oscillations, transcranial alternating current stimulation (tACS) has proven to be a useful neuroscientific tool. Because of the excessive tACS-caused artifact at the stimulation frequency in electroencephalography (EEG) signals, tACS + EEG studies have been mostly limited to compare brain activity between recordings before and after concurrent tACS. Critically, attempts to suppress the artifact in the data cannot assure that the entire artifact is removed while brain activity is preserved. The current study aims to evaluate the feasibility of specific artifact correction techniques to clean tACS-contaminated EEG data.

New Method

In the first experiment, we used a phantom head to have full control over the signal to be analyzed. Driving pre-recorded human brain-oscillation signals through a dipolar current source within the phantom, we simultaneously applied tACS and compared the performance of different artifact-correction techniques: sine subtraction, template subtraction, and signal-space projection (SSP). In the second experiment, we combined tACS and EEG on one human subject to demonstrate the best-performing data-correction approach in a proof of principle.

Results

The tACS artifact was highly attenuated by SSP in the phantom and the human EEG; thus, we were able to recover the amplitude and phase of the oscillatory activity. In the human experiment, event-related desynchronization could be restored after correcting the artifact.

Comparison With Existing Methods

The best results were achieved with SSP, which outperformed sine subtraction and template subtraction.

Conclusion

Our results demonstrate the feasibility of SSP by applying it to a phantom measurement with pre-recorded signal and one human tACS + EEG dataset. For a full validation of SSP, more data are needed.

The Modulation of Cognitive Performance with Transcranial Alternating Current Stimulation: A Systematic Review of Frequency-Specific Effects

Transcranial alternating current stimulation (tACS) is a non-invasive brain stimulation technique that allows the manipulation of intrinsic brain oscillations. Numerous studies have applied tACS in the laboratory to enhance cognitive performance. With this systematic review, we aim to provide an overview of frequency-specific tACS effects on a range of cognitive functions in healthy adults. This may help to transfer stimulation protocols to real-world applications. We conducted a systematic literature search on PubMed and Cochrane databases and considered tACS studies in healthy adults (age > 18 years) that focused on cognitive performance. The search yielded n = 109 studies, of which n = 57 met the inclusion criteria. The results indicate that theta-tACS was beneficial for several cognitive functions, including working memory, executive functions, and declarative memory. Gamma-tACS enhanced performance in both auditory and visual perception but it did not change performance in tasks of executive functions. For attention, the results were less consistent but point to an improvement in performance with alpha- or gamma-tACS. We discuss these findings and point to important considerations that would precede a transfer to real-world applications.

Discrete sampling in perception via neuronal oscillations-Evidence from rhythmic, non-invasive brain stimulation

A variety of perceptual phenomena suggest that, in contrast to our everyday experience, our perception may be discrete rather than continuous. The possibility of such discrete sampling processes inevitably prompts the question of how such discretization is implemented in the brain. Evidence from neurophysiological measurements suggest that neural oscillations, particularly in the lower frequencies, may provide a mechanism by which such discretization can be implemented. It is hypothesized that cortical excitability is rhythmically enhanced or reduced along the positive and negative half-cycle of such oscillations. In recent years, rhythmic non-invasive brain stimulation approaches such as rhythmic transcranial magnetic stimulation (rTMS) and transcranial alternating current stimulation (tACS) are increasingly used to test this hypothesis. Both methods are thought to entrain endogenous brain oscillations, allowing them to alter their power, frequency, and phase in order to study their roles in perception. After a brief introduction to the core mechanisms of both methods, we will provide an overview of rTMS and tACS studies probing the role of brain oscillations for discretized perception in different domains and will contrast these results with unsuccessful attempts. Further, we will discuss methodological pitfalls and challenges associated with the methods.

Hemisphere-specific, differential effects of lateralized, occipital-parietal α- versus γ-tACS on endogenous but not exogenous visual-spatial attention

Orienting spatial attention has been associated with interhemispheric asymmetry of power in the α- and γ-band. Specifically, increased α-power has been linked to the inhibition of unattended sensory streams (e.g. the unattended visual field), while increased γ-power is associated with active sensory processing. Here, we aimed to differentially modulate endogenous and exogenous visual-spatial attention using transcranial alternating current stimulation (tACS). In a single-blind, within-subject design, participants performed several blocks of a spatial cueing task comprised of endogenous and exogenous cues while receiving lateralized α- or γ-tACS or no stimulation over left or right occipital-parietal areas. We found a significant, differential effect of α- and γ-tACS on endogenous (top-down) spatial attention but not on exogenous (bottom-up) attention. The effect was specific to tACS applied to the left hemisphere and driven by a modulation of attentional disengagement and re-orientation as measured during invalid trials. Our results indicate a causal role of α-/γ-oscillations for top-down (endogenous) attention. They may further suggest a left hemispheric dominance in controlling interhemispheric α-/γ-power asymmetry. The absence of an effect on exogenous attention may be indicative of a differential role of α-/γ-oscillations during different attention types or spatially distinct attentional subsystems.

The efficacy of transcranial alternating current stimulation for treating post-stroke depression: Study Protocol Clinical Trial (SPIRIT Compliant)

BACKGROUND

The treatment of post-stroke depression (PSD) with anti-depressant drugs is partly practical. Transcranial alternating current stimulation (tACS) offers the potential for a novel treatment modality for adult patients with PSD. In this study, we will assess the efficacy and safety of tACS for treating PSD and explore its effect on gamma and beta-oscillations involving in emotional regulation.

METHODS

The prospective study is an 8-week, double-blind, randomized, placebo-controlled trial. Seventy eligible participants with mild to moderate PSD aged between 18 years and 70 years will be recruited and randomly assigned to either active tACS intervention group or sham group. Daily 40-minute, 77.5-Hz, 15-mA sessions of active or sham tACS targeting the forehead and both mastoid areas on weekdays for 4 consecutive weeks (week 4), and an additional 4-week observational period (week 8) will be followed up. The primary outcome is the proportion of participants having an improvement at week 8 according to the Hamilton Depression Rating Scale 17-Item (HAMD-17) score, including the proportion of participants having a decrease of ≥ 50% in HAMD-17 score or clinical recovery (HAMD-17 score ≤ 7). Secondary outcomes include neurological function, independence level, activities of daily living, disease severity, anxiety, and cognitive function. The exploratory outcomes are gamma and beta-oscillations assessed at baseline, week 4, and week 8. Data will be analyzed by logistical regression analyses and mixed-effects models.

DISCUSSION

The study will be the first randomized controlled trial to evaluate the efficacy and safety of tACS at a 77.5-Hz frequency and 15-mA current in reducing depressive severity in patients with PSD. The results of the study will present a base for future studies on the tACS in PSD and its possible mechanism.

TRIAL REGISTRATION NUMBER

NCT03903068, pre-results.

Discordant Alpha-Band Transcranial Alternating Current Stimulation Affects Cortico-Cortical and Cortico-Cerebellar Connectivity

Synchronization of oscillatory brain activity is believed to play a critical role in linking distributed neuronal populations into transient functional networks. Alpha-band alternating current stimulation (tACS) was applied over bilateral parietal cortex in a double-blind sham-controlled study to test the notion that widespread alpha mediates causal relationships in the gamma-band both within local neuronal populations and also across distant brain regions. Causal relationships of oscillatory alpha- and gamma-band activity were characterized during performance of a visual global/local attention task. Nonfocal and nonphase-locked tACS, discordant with endogenous oscillatory activity, was hypothesized to induce a performance deficit and differences in network-level causal relationships between both cortical and subcortical brain regions. Although modulation of fronto-parieto-cerebellar causal relationships was observed following stimulation, there was no evidence for a behavioral deficit. We propose that olivo-cerebellar circuits may have responded to the discordant tACS-induced currents as if they were "error signals" in the context of ongoing functional alpha-band brain dynamics. Compensatory cerebellar activity may have contributed to the lack of behavioral deficits and to differences in causal relationships observed following stimulation. Understanding a potential compensatory mechanism involving short-term plasticity in the cerebellum may be critical to developing potential clinical applications of tACS, particularly for disorders such as autism that are characterized by both atypical cortical and cerebellar dynamics.

Protocol on transcranial alternating current stimulation for the treatment of major depressive disorder: a randomized controlled trial

BACKGROUND

Transcranial alternating current stimulation (tACS) offers a new approach for adult patients with major depressive disorder (MDD). The study is to evaluate the efficacy and safety of tACS treating MDD.

METHODS

This is an 8-week, double-blind, randomized, placebo-controlled study. Ninety-two drug-naive patients with MDD aged 18 to 65 years will receive 20 daily 40-min, 77.5-Hz, 15-mA sessions of active or sham tACS targeting the forehead and both mastoid areas on weekdays for 4 consecutive weeks (week 4), following a 4-week observation period (week 8). The primary outcome is the remission rate defined as the 17-item Hamilton depression rating scale (HDRS-17) score ≤7 at week 8. Secondary outcomes are the rates of response at weeks 4 and 8 and rate of remission at week 4 based on HDRS-17, the proportion of participants having improvement in the clinical global impression-improvement, the change in HDRS-17 score (range, 0-52, with higher scores indicating more depression) over the study, and variations of brain imaging and neurocognition from baseline to week 4. Safety will be assessed by vital signs at weeks 4 and 8, and adverse events will be collected during the entire study.

DISCUSSION

The tACS applied in this trial may have treatment effects on MDD with minimal side effects.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1800016479; http://www.chictr.org.cn/showproj.aspx?proj=22048.

Parietal tACS at beta frequency improves vision in a crowding regime

Visual crowding is the inability to discriminate objects when presented with nearby flankers and sets a fundamental limit for conscious perception. Beta oscillations in the parietal cortex were found to be associated to crowding, with higher beta amplitude related to better crowding resilience. An open question is whether beta activity directly and selectively modulates crowding. We employed Transcranial Alternating Current Stimulation (tACS) in the beta band (18-Hz), in the alpha band (10-Hz) or in a sham regime, asking whether 18-Hz tACS would selectively improve the perception of crowded stimuli by increasing parietal beta activity. Resting-state electroencephalography (EEG) was measured before and after stimulation to test the influence of tACS on endogenous oscillations. Consistently with our predictions, we found that 18-Hz tACS, as compared to 10-Hz tACS and sham stimulation, reduced crowding. This improvement was found specifically in the contralateral visual hemifield and was accompanied by an increased amplitude of EEG beta oscillations, confirming an effect on endogenous brain rhythms. These results support a causal relationship between parietal beta oscillations and visual crowding and provide new insights into the precise oscillatory mechanisms involved in human vision.

Integrating electric field modeling and neuroimaging to explain inter-individual variability of tACS effects

Transcranial electrical stimulation (tES) of the brain can have variable effects, plausibly driven by individual differences in neuroanatomy and resulting differences of the electric fields inside the brain. Here, we integrated individual simulations of electric fields during tES with source localization to predict variability of transcranial alternating current stimulation (tACS) aftereffects on α-oscillations. In two experiments, participants received 20-min of either α-tACS (1 mA) or sham stimulation. Magnetoencephalogram (MEG) was recorded for 10-min before and after stimulation. tACS caused a larger power increase in the α-band compared to sham. The variability of this effect was significantly predicted by measures derived from individual electric field modeling. Our results directly link electric field variability to variability of tACS outcomes, underline the importance of individualizing stimulation protocols, and provide a novel approach to analyze tACS effects in terms of dose-response relationships.

Left parietal tACS at alpha frequency induces a shift of visuospatial attention

BACKGROUND

Voluntary shifts of visuospatial attention are associated with a lateralization of parieto-occipital alpha power (7-13Hz), i.e. higher power in the hemisphere ipsilateral and lower power contralateral to the locus of attention. Recent noninvasive neuromodulation studies demonstrated that alpha power can be experimentally increased using transcranial alternating current stimulation (tACS).

OBJECTIVE/HYPOTHESIS

We hypothesized that tACS at alpha frequency over the left parietal cortex induces shifts of attention to the left hemifield. However, spatial attention shifts not only occur voluntarily (endogenous/ top-down), but also stimulus-driven (exogenous/ bottom-up). To study the task-specificity of the potential effects of tACS on attentional processes, we administered three conceptually different spatial attention tasks.

METHODS

36 healthy volunteers were recruited from an academic environment. In two separate sessions, we applied either high-density tACS at 10Hz, or sham tACS, for 35-40 minutes to their left parietal cortex. We systematically compared performance on endogenous attention, exogenous attention, and stimulus detection tasks.

RESULTS

In the endogenous attention task, a greater leftward bias in reaction times was induced during left parietal 10Hz tACS as compared to sham. There were no stimulation effects in either the exogenous attention or the stimulus detection task.

CONCLUSION

The study demonstrates that high-density tACS at 10Hz can be used to modulate visuospatial attention performance. The tACS effect is task-specific, indicating that not all forms of attention are equally susceptible to the stimulation.

Challenges of P300 Modulation Using Transcranial Alternating Current Stimulation (tACS)

The P300 component of the event-related potential (ERP) is a well investigated phenomenon in the human electroencephalogram (EEG) and has been related to stimulus processing and attentional mechanisms. Event-related oscillations (ERO) represent a potential mechanism responsible for generating the ERP. In particular, oscillatory activity in the delta and theta frequency range has been associated with the generation of the P300 component. Transcranial Alternating Current Stimulation (tACS) is capable of modulating oscillatory brain activity in a frequency-specific manner. In this study, we aimed to modulate P300 amplitude using tACS by stimulating the individual ERO involved in the generation of the P300 component. TACS was applied precisely in time to the target P300 occurring in a visual oddball task. In order to achieve an appropriate current distribution, we designed an electrode configuration consisting of two clusters of stimulation electrodes on central-parietal locations. We could not demonstrate a group difference in P300 amplitude after applying tACS in the stimulation condition (N = 17) vs. the sham condition (N = 11). TACS condition and sham condition did not differ regarding their reaction times in response to target stimuli or their event-related spectral perturbation (ERSP) at stimulation frequency. Although a significant influence of stimulation could not yet be revealed on a statistical level, we suggest that the proposed method of using tACS for modulating EROs merits further investigation. Modulation of the P300 component in the ERP could help to gain further insights in the role of EROs generating ERPs and the functional relevance of the P300 component. In this study, we propose a novel approach of applying tACS and provide advice on using tACS for the modulation of EROs.

Low-frequency alternating current stimulation rhythmically suppresses gamma-band oscillations and impairs perceptual performance

Low frequency oscillations such as alpha (8-12 Hz) are hypothesized to rhythmically gate sensory processing, reflected by 40-100 Hz gamma band activity, via the mechanism of pulsed inhibition. We applied transcranial alternating current stimulation (TACS) at individual alpha frequency (IAF) and flanking frequencies (IAF-4 Hz, IAF+4 Hz) to the occipital cortex of healthy human volunteers during concurrent magnetoencephalography (MEG), while participants performed a visual detection task inducing strong gamma-band responses. Occipital (but not retinal) TACS phasically suppressed stimulus-induced gamma oscillations in the visual cortex and impaired target detection, with stronger phase-to-amplitude coupling predicting behavioral impairments. Retinal control TACS ruled out retino-thalamo-cortical entrainment resulting from (subthreshold) retinal stimulation. All TACS frequencies tested were effective, suggesting that visual gamma-band responses can be modulated by a range of low frequency oscillations. We propose that TACS-induced membrane potential modulations mimic the rhythmic change in cortical excitability by which spontaneous low frequency oscillations may eventually exert their impact when gating sensory processing via pulsed inhibition.