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Bikson M, Ganho-Ávila A, Datta A, Gillick B, Joensson MG, Kim S, Kim J, Kirton A, Lee K, Marjenin T, Onarheim B, Rehn EM, Sack AT, Unal G. Limited output transcranial electrical stimulation 2023 (LOTES-2023): Updates on engineering principles, regulatory statutes, and industry standards for wellness, over-the-counter, or prescription devices with low risk. Brain Stimul 2023; 16:840-853. [PMID: 37201865 PMCID: PMC10350287 DOI: 10.1016/j.brs.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/20/2023] Open
Abstract
The objective and scope of this Limited Output Transcranial Electrical Stimulation 2023 (LOTES-2023) guidance is to update the previous LOTES-2017 guidance. These documents should therefore be considered together. The LOTES provides a clearly articulated and transparent framework for the design of devices providing limited output (specified low-intensity range) transcranial electrical stimulation for a variety of intended uses. These guidelines can inform trial design and regulatory decisions, but most directly inform manufacturer activities - and hence were presented in LOTES-2017 as "Voluntary industry standard for compliance controlled limited output tES devices". In LOTES-2023 we emphasize that these standards are largely aligned across international standards and national regulations (including those in USA, EU, and South Korea), and so might be better understood as "Industry standards for compliance controlled limited output tES devices". LOTES-2023 is therefore updated to reflect a consensus among emerging international standards, as well as best available scientific evidence. "Warnings" and "Precautions" are updated to align with current biomedical evidence and applications. LOTES standards applied to a constrained device dose range, but within this dose range and for different use-cases, manufacturers are responsible to conduct device-specific risk management.
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Affiliation(s)
- Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States.
| | - Ana Ganho-Ávila
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention-CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Abhishek Datta
- Research and Development, Soterix Medical Inc., Woodbridge, NJ, United States
| | - Bernadette Gillick
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Sungjin Kim
- Ybrain Research Institute, Seongnam-si, Gyeonggi-do, South Korea
| | - Jinuk Kim
- Ybrain Research Institute, Seongnam-si, Gyeonggi-do, South Korea
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kiwon Lee
- Ybrain Research Institute, Seongnam-si, Gyeonggi-do, South Korea
| | | | - Balder Onarheim
- Research and Development, PlatoScience ApS, Copenhagen, Denmark
| | - Erik M Rehn
- Research and Development, Flow Neuroscience, Malmo, Skane Lan, Sweden
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Gozde Unal
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States.
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Hong KS, Khan MNA, Ghafoor U. Non-invasive transcranial electrical brain stimulation guided by functional near-infrared spectroscopy for targeted neuromodulation: A review. J Neural Eng 2022; 19. [PMID: 35905708 DOI: 10.1088/1741-2552/ac857d] [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] [Received: 02/16/2021] [Accepted: 07/29/2022] [Indexed: 11/12/2022]
Abstract
One of the primary goals in cognitive neuroscience is to understand the neural mechanisms on which cognition is based. Researchers are trying to find how cognitive mechanisms are related to oscillations generated due to brain activity. The research focused on this topic has been considerably aided by developing non-invasive brain stimulation techniques. The dynamics of brain networks and the resultant behavior can be affected by non-invasive brain stimulation techniques, which make their use a focus of interest in many experiments and clinical fields. One essential non-invasive brain stimulation technique is transcranial electrical stimulation (tES), subdivided into transcranial direct and alternating current stimulation. tES has recently become more well-known because of the effective results achieved in treating chronic conditions. In addition, there has been exceptional progress in the interpretation and feasibility of tES techniques. Summarizing the beneficial effects of tES, this article provides an updated depiction of what has been accomplished to date, brief history, and the open questions that need to be addressed in the future. An essential issue in the field of tES is stimulation duration. This review briefly covers the stimulation durations that have been utilized in the field while monitoring the brain using functional-near infrared spectroscopy-based brain imaging.
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Affiliation(s)
- Keum-Shik Hong
- Department of Cogno-mechatronics Engineering, Pusan National University, 2 Busandaehak-ro, Geumgeong-gu, Busan, Busan, 609735, Korea (the Republic of)
| | - M N Afzal Khan
- Pusan National University, Department of Mechanical Engineering, Busan, 46241, Korea (the Republic of)
| | - Usman Ghafoor
- School of Mechanical Engineering, Pusan National University College of Engineering, room 204, Busan, 46241, Korea (the Republic of)
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Ko MH. Safety of Transcranial Direct Current Stimulation in Neurorehabilitation. BRAIN & NEUROREHABILITATION 2021; 14:e9. [PMID: 36742105 PMCID: PMC9879413 DOI: 10.12786/bn.2021.14.e9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/08/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has considerable potential as a useful method in the field of neurorehabilitation. However, the safety of tDCS for the human is primarily based on theoretical evidence related to electricity, and the safety information of applying tDCS to the human is only available from researcher's reporting. Based on tDCS studies with human and animal subjects and simulation-based studies of the safety of current stimulation in the past 20 years, this review investigated the safety of tDCS application to the human body. No severe complications have been reported in either adults or children for tDCS at an intensity of 4 mA or less, within a period of 60 minutes per day, using commonly applied 25 or 35 cm2 electrodes. According to animal studies, the amount of electricity used for tDCS is less than 5% of the amount that permanently changes brain tissue, thereby ensuring safety to a certain extent. In order to increase the efficacy of tDCS for neurorehabilitation and to minimize even trivial complications in the human screening of exclusion criteria should be conducted with detailed observations of complications.
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Affiliation(s)
- Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
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Lerma-Lara S, De Cherade Montbron M, Guérin M, Cuenca-Martínez F, La Touche R. Transcranial direct-current stimulation (tDCS) in the primary motor cortex and its effects on sensorimotor function: a quasi-experimental single-blind sham-controlled trial. Sci Rep 2021; 11:6566. [PMID: 33753853 PMCID: PMC7985198 DOI: 10.1038/s41598-021-85989-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022] Open
Abstract
The main aim was to assess the short-term effects of active-tDCS (a-tDCS) in the primary motor cortex (anodal stimulation-M1) on sensorimotor variables. These variables included discriminative sensation through the two-point discrimination (2-PD) test, tactile acuity threshold and pressure pain threshold (PPT), and electromyographic (EMG) activity compared with a sham-tDCS (s-tDCS) in healthy individuals. A total of 100 participants were included. Fifty of the participants received the a-tDCS application of 2 mA for 20 min, whereas the remaining fifty received the s-tDCS. The 2-PD and tactile acuity threshold in thenar eminence of the hand and in the dorsal part of the foot and also, PPT and EMG activity during maximal voluntary contraction in the biceps brachii and rectus femoris were assessed before and after the tDCS application. The a-tDCS intervention was not significantly superior to the s-tDCS in any variable. However, significant within-group pre- and post-intervention differences were found in the a-tDCS, such as the tactile acuity threshold in thenar eminence of the hand, with a small effect size (p = .012, d = 0.20) and in the PPT of the rectus femoris, also with a small effect size (p = .001, d = - 0.17). Regarding EMG activity, a trend towards greater activity was observed in participants with a-tDCS compared with s-tDCS, which showed a trend towards decreased EMG activity. In fact, although no differences were found between the groups, within-group differences were statistically significant in the biceps brachii pre- and postintervention (p = .023, d = - 0.16, and p = .002, d = 0.18, respectively), and also in the rectus femoris, only in the a-tDCS, with a small effect size (p = .011, d = - 0.14). This study showed no significant between-group differences in sensorimotor outcomes. A single session of tDCS in isolation appears to produce immediate effects in healthy participants on sensorimotor function; however, these effects were very small.
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Affiliation(s)
- Sergio Lerma-Lara
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, C/ La Salle, No. 10, 28023, Madrid, Spain.
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - Marina De Cherade Montbron
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, C/ La Salle, No. 10, 28023, Madrid, Spain
| | - Mathias Guérin
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, C/ La Salle, No. 10, 28023, Madrid, Spain
| | - Ferran Cuenca-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, C/ La Salle, No. 10, 28023, Madrid, Spain.
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, C/ La Salle, No. 10, 28023, Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, Spain
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