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Terranova S, Botta A, Putzolu M, Bonassi G, Cosentino C, Mezzarobba S, Ravizzotti E, Pelosin E, Avanzino L. Cerebellar Direct Current Stimulation Reveals the Causal Role of the Cerebellum in Temporal Prediction. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1386-1398. [PMID: 38147293 DOI: 10.1007/s12311-023-01649-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 12/27/2023]
Abstract
Temporal prediction (TP) influences our perception and cognition. The cerebellum could mediate this multi-level ability in a context-dependent manner. We tested whether a modulation of the cerebellar neural activity, induced by transcranial Direct Current Stimulation (tDCS), changed the TP ability according to the temporal features of the context and the duration of target interval. Fifteen healthy participants received anodal, cathodal, and sham tDCS (15 min × 2 mA intensity) over the right cerebellar hemisphere during a TP task. We recorded reaction times (RTs) to a target during the task in two contextual conditions of temporal anticipation: rhythmic (i.e., interstimulus intervals (ISIs) were constant) and single-interval condition (i.e., the estimation of the timing of the target was based on the prior exposure of the train of stimuli). Two ISIs durations were explored: 600 ms (short trials) and 900 ms (long trials). Cathodal tDCS improved the performance during the TP task (shorter RTs) specifically in the rhythmic condition only for the short trials and in the single-interval condition only for the long trials. Our results suggest that the inhibition of cerebellar activity induced a different improvement in the TP ability according to the temporal features of the context. In the rhythmic context, the cerebellum could integrate the temporal estimation with the anticipatory motor responses critically for the short target interval. In the single-interval context, for the long trials, the cerebellum could play a main role in integrating representation of time interval in memory with the elapsed time providing an accurate temporal prediction.
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Affiliation(s)
- Sara Terranova
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, 16132, Genoa, Italy
| | | | - Martina Putzolu
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, 16132, Genoa, Italy
| | - Gaia Bonassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Largo Paolo Daneo 3, 16132, Genoa, Italy
| | - Carola Cosentino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Largo Paolo Daneo 3, 16132, Genoa, Italy
| | - Susanna Mezzarobba
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Largo Paolo Daneo 3, 16132, Genoa, Italy
| | - Elisa Ravizzotti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Largo Paolo Daneo 3, 16132, Genoa, Italy
| | - Elisa Pelosin
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Largo Paolo Daneo 3, 16132, Genoa, Italy.
| | - Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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2
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Razavi MS, Fathi M, Vahednia E, Ardani AR, Honari S, Akbarzadeh F, Talaei A. Cognitive rehabilitation in bipolar spectrum disorder: A systematic review. IBRO Neurosci Rep 2024; 16:509-517. [PMID: 38645887 PMCID: PMC11033165 DOI: 10.1016/j.ibneur.2024.04.001] [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: 11/08/2023] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024] Open
Abstract
Background and objectives Neurocognitive deficits in bipolar disorder (BD) have a negative impact on the quality of life, even during the euthymic phase. And many studies conducted to improve cognitive deficits in bipolar disorder. This systematic review aims to summarize studies on cognitive rehabilitation (CR) conducted in bipolar patients and evaluate its impact on neurocognitive deficits. The primary objective is to explore how CR interventions can enhance cognitive functioning, treatment outcomes, and overall quality of life in this population. Methods A comprehensive search was conducted on PubMed, Google Scholar, Scopus, Embase, and PsycINFO databases from 1950 to 2023, following the 2015 PRISMA-P guidelines, using search terms related to BD and CR. Results The initial search yielded 371 titles across the five databases. After applying inclusion and exclusion criteria through screening, a total of 23 articles were included in the study. The selected articles evaluated verbal memory, attention, executive functions, and social cognition. Conclusion The findings suggest that CR can be an effective treatment approach for bipolar patients, aimed at enhancing their cognitive abilities, treatment outcomes, and overall quality of life. The primary finding of this study indicates that cognitive-behavioral therapy (CBT) protocols, skill training, and homework exercises, which offer a daily structure, social support, and opportunities for exchanging coping strategies, are more effective in enhancing cognitive functions. However, it is important to acknowledge the notable limitations of this review. Firstly, we did not assess the methodological rigor of the included studies. Additionally, there was a lack of detailed analysis regarding specific cognitive rehabilitation approaches that adhere to core CR principles, resulting in increased heterogeneity within the reviewed studies.
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Affiliation(s)
| | | | - Elham Vahednia
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Rezaei Ardani
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Honari
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Akbarzadeh
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Talaei
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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3
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Tai H, Kandeel N, Menon M, Ibrahim A, Choo B, Santana R, Jolayemi A. Role of the Cerebellum in Bipolar Disorder: A Systematic Literature Review. Cureus 2024; 16:e56044. [PMID: 38606213 PMCID: PMC11008919 DOI: 10.7759/cureus.56044] [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] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
The aim of this systematic literature review was to investigate the role of the cerebellum in the affective symptoms observed in patients with bipolar disorder. The present systematic literature review included clinical studies conducted from 2013-2023 among adult populations with bipolar I and II disorders, along with their specifiers. With regard to cerebellar pathology, it was found that those with bipolar disorder performed worse than their healthy counterparts in their ability to comprehend the mental states of others and in identifying negative mental states. Additionally, individuals with bipolar disorder had reduced gray matter loss in regions such as lobules I-IX, crus I, and crus II, different functional activation patterns of the thalamus, striatum, and hippocampus on functional magnetic resonance imaging (fMRI), and increased cortical thickness. Cerebro-cerebellar functional connectivities were altered in patients with bipolar disorder. The effects of lamotrigine and lithium on cerebellar volume and abnormalities are also discussed in this paper. The present systematic literature review illustrates the emerging involvement of the cerebellum in bipolar disorder and its affective symptoms and paves the way for future research and a better understanding of bipolar disorder.
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Affiliation(s)
- Hina Tai
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Nermien Kandeel
- Medicine, American University of Antigua, New York City, USA
| | - Maya Menon
- Medicine, American University of Antigua, New York City, USA
| | - Andrew Ibrahim
- Medicine, Saba University School of Medicine, The Bottom, NLD
| | - Byeongyeon Choo
- Medicine, American University of Antigua, New York City, USA
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4
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Neurological soft signs are increased in migraine without aura: relationship with the affective status. Neurol Sci 2022; 43:6039-6045. [PMID: 35585436 PMCID: PMC9474476 DOI: 10.1007/s10072-022-06143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/13/2022] [Indexed: 11/21/2022]
Abstract
Introduction Neurological soft signs (NSS) are subtle non-localizing sensorimotor abnormalities initially reported as increased in primary headache patients. The aims of this study were confirming with full power NSS increased expression in migraine and, collaterally, determining if psychiatric traits or white matter lesions at brain imaging could influence this result. Methods Forty drug-free episodic migraine outpatients (MH) were recruited with 40 matched controls. NSS were determined by the 16-item Heidelberg scale; depression, anxiety and QoL by the HAM-D; the STAI-X1/X2; and the SF36, respectively. The Fazekas scale on brain MR studies was applied in n = 32 MH, unravelling deep white matter signal alterations (DWM). MH characteristics, including the headache disability inventory (HDI), were recorded. Results NSS were 46% increased in MH vs. controls (p = 0.0001). HAM-D and STAI-X1/X2 were increased in MH, while SF36 was unchanged, but they all failed to influence NSS, just as MH characteristics. NSS scores were increased in MH-DWM + (n = 11, + 85%) vs. MH-DWM − (n = 21, + 27%) vs. controls (p < 0.0001). NSS increased expression in MH was influenced by DWM, while psychiatric traits and headache characteristics failed to do so. Discussion/conclusions NSS are increased in MH and probably not influenced by the affective status, possibly marking a dysfunction within the cerebellar-thalamic-prefrontal circuit that may deserve further attention from the prognostic point of view.
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Au J, Smith-Peirce RN, Carbone E, Moon A, Evans M, Jonides J, Jaeggi SM. Effects of Multisession Prefrontal Transcranial Direct Current Stimulation on Long-term Memory and Working Memory in Older Adults. J Cogn Neurosci 2022; 34:1015-1037. [PMID: 35195728 PMCID: PMC9836784 DOI: 10.1162/jocn_a_01839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive form of electrical brain stimulation popularly used to augment the effects of working memory (WM) training. Although success has been mixed, some studies report enhancements in WM performance persisting days, weeks, or even months that are actually more reminiscent of consolidation effects typically observed in the long-term memory (LTM) domain, rather than WM improvements per se. Although tDCS has been often reported to enhance both WM and LTM, these effects have never been directly compared within the same study. However, given their considerable neural and behavioral overlap, this is a timely comparison to make. This study reports results from a multisession intervention in older adults comparing active and sham tDCS over the left dorsolateral pFC during training on both an n-back WM task and a word learning LTM task. We found strong and robust effects on LTM, but mixed effects on WM that only emerged for those with lower baseline ability. Importantly, mediation analyses showed an indirect effect of tDCS on WM that was mediated by improvements in consolidation. We conclude that tDCS over the left dorsolateral pFC can be used as an effective intervention to foster long-term learning and memory consolidation in aging, which can manifest in performance improvements across multiple memory domains.
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Affiliation(s)
- Jacky Au
- School of Education, University of California, Irvine, Irvine CA, 92697, USA
| | | | - Elena Carbone
- Department of General Psychology, University of Padova, Padova, 35131, Italy
| | - Austin Moon
- Department of Psychology, University of California, Riverside, Riverside CA, 92521, USA
| | - Michelle Evans
- Department of Psychology, University of Michigan, Ann Arbor MI, 48109, USA
| | - John Jonides
- Department of Psychology, University of Michigan, Ann Arbor MI, 48109, USA
| | - Susanne M. Jaeggi
- School of Education, University of California, Irvine, Irvine CA, 92697, USA
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6
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Bi B, Che D, Bai Y. Neural network of bipolar disorder: Toward integration of neuroimaging and neurocircuit-based treatment strategies. Transl Psychiatry 2022; 12:143. [PMID: 35383150 PMCID: PMC8983759 DOI: 10.1038/s41398-022-01917-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 01/23/2023] Open
Abstract
Bipolar disorder (BD) is a complex psychiatric disorder characterized by dysfunctions in three domains including emotional processing, cognitive processing, and psychomotor dimensions. However, the neural underpinnings underlying these clinical profiles are not well understood. Based on the reported data, we hypothesized that (i) the core neuropathology in BD is damage in fronto-limbic network, which is associated with emotional dysfunction; (ii) changes in intrinsic brain network, such as sensorimotor network, salience network, default-mode network, central executive network are associated with impaired cognition function; and (iii) beyond the dopaminergic-driven basal ganglia-thalamo-cortical motor circuit modulated by other neurotransmitter systems, such as serotonin (subcortical-cortical modulation), the sensorimotor network and related motor function modulated by other non-motor networks such as the default-mode network are involved in psychomotor function. In this review, we propose a neurocircuit-based clinical characteristics and taxonomy to guide the treatment of BD. We draw on findings from neuropsychological and neuroimaging studies in BD and link variations in these clinical profiles to underlying neurocircuit dysfunctions. We consider pharmacological, psychotherapy, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions in BD. Finally, it is suggested that the methods of testing the neurocircuit-based taxonomy and important limitations to this approach should be considered in future.
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Affiliation(s)
- Bo Bi
- Department of Clinical Psychology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.
| | - Dongfang Che
- grid.452787.b0000 0004 1806 5224Neurosurgery department, Shenzhen Children’s Hospital, Shenzhen, China
| | - Yuyin Bai
- grid.12981.330000 0001 2360 039XDepartment of Clinical Psychology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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7
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Van Overwalle F, Pu M, Ma Q, Li M, Haihambo N, Baetens K, Deroost N, Baeken C, Heleven E. The Involvement of the Posterior Cerebellum in Reconstructing and Predicting Social Action Sequences. THE CEREBELLUM 2021; 21:733-741. [PMID: 34694590 DOI: 10.1007/s12311-021-01333-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/30/2022]
Abstract
Recent advances in social neuroscience have highlighted the critical role of the cerebellum and especially the posterior cerebellar Crus in social mentalizing (i.e., theory of mind). Research in the past 5 years has provided growing evidence supporting the view that the posterior cerebellum builds internal action models of our social interactions to predict how other people's actions will be executed, and what our most likely responses to these actions will be. This paper presents an overview of a series of fMRI experiments on novel tasks involving a combination of (a) the learning or generation of chronological sequences of social actions either in an explicit or implicit manner, which (b) require social mentalizing on another person's mental state such as goals, beliefs, and implied traits. Together, the results strongly confirm the central role of the posterior cerebellar Crus in identifying and automatizing action sequencing during social mentalizing, and in predicting future action sequences based on social mentalizing inferences about others. This research program has important implications: It provides for the first time (a) fruitful starting points for diagnosing and investigating social sequencing dysfunctions in a variety of mental disorders which have also been related to cerebellar dysfunctions, (b) provides the necessary tools for testing whether non-invasive neurostimulation targeting the posterior cerebellum has a causal effect on social functioning, and (c) whether these stimulation techniques and training programs guided by novel cerebellar social sequencing insights, can be exploited to increase posterior cerebellar plasticity in order to alleviate social impairments in mental disorders.
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Affiliation(s)
- Frank Van Overwalle
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium.
| | - Min Pu
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium
| | - Qianying Ma
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium
| | - Meijia Li
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium
| | - Naem Haihambo
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium
| | - Kris Baetens
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium
| | - Natacha Deroost
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium
| | - Chris Baeken
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium
| | - Elien Heleven
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium
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8
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Van Overwalle F, Baeken C, Campanella S, Crunelle CL, Heleven E, Kornreich C, Leggio M, Noël X, Vanderhasselt MA, Baetens K. The Role of the Posterior Cerebellum in Dysfunctional Social Sequencing. THE CEREBELLUM 2021; 21:1123-1134. [PMID: 34637054 DOI: 10.1007/s12311-021-01330-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 01/19/2023]
Abstract
Recent advances in social neuroscience have highlighted the critical role of the cerebellum in social cognition, and especially the posterior cerebellum. Studies have supported the view that the posterior cerebellum builds internal action models of our social interactions to predict how other people's actions will be executed and what our most likely responses are to these actions. This mechanism allows to better anticipate action sequences during social interactions in an automatic and intuitive way and to fine-tune these anticipations, making it easier to understand other's social behaviors and mental states (e.g., beliefs, intentions, traits). In this paper, we argue that the central role of the posterior cerebellum in identifying and automatizing social action sequencing provides a fruitful starting point for investigating social dysfunctions in a variety of clinical pathologies, such as autism, obsessive-compulsive and bipolar disorder, depression, and addiction. Our key hypothesis is that dysfunctions of the posterior cerebellum lead to under- or overuse of inflexible social routines and lack of plasticity for learning new, more adaptive, social automatisms. We briefly review past research supporting this view and propose a program of research to test our hypothesis. This approach might alleviate a variety of mental problems of individuals who suffer from inflexible automatizations that stand in the way of adjustable and intuitive social behavior, by increasing posterior cerebellar plasticity using noninvasive neurostimulation or neuro-guided training programs.
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Affiliation(s)
- Frank Van Overwalle
- Department of Psychology & Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium.
| | - Chris Baeken
- Department of Psychology & Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium.,Department of Psychiatry, Vrije Universiteit Brussel & Universitair Ziekenhuis Brussel, Brussel, Belgium.,Department of Psychiatry, Ghent Experimental Psychiatry Lab, Ghent University, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Salvatore Campanella
- Laboratoire de Psychologie Médicale Et d'Addictologie, Faculty of Medicine, Université Libre de Bruxelles, Bruxelles, Belgium.,UNI Neuroscience Institute, Université Libre de Bruxelles, Bruxelles, Belgium.,Faculty of Psychology, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Cleo L Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel & Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Elien Heleven
- Department of Psychology & Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium
| | - Charles Kornreich
- Laboratoire de Psychologie Médicale Et d'Addictologie, Faculty of Medicine, Université Libre de Bruxelles, Bruxelles, Belgium.,UNI Neuroscience Institute, Université Libre de Bruxelles, Bruxelles, Belgium.,Faculty of Psychology, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Maria Leggio
- Department of Psychology & Ataxia Laboratory, Fondazione Santa Lucia IRCCS, Sapienza University of Roma, Rome, Italy
| | - Xavier Noël
- Laboratoire de Psychologie Médicale Et d'Addictologie, Faculty of Medicine, Université Libre de Bruxelles, Bruxelles, Belgium.,UNI Neuroscience Institute, Université Libre de Bruxelles, Bruxelles, Belgium.,Faculty of Psychology, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | - Kris Baetens
- Department of Psychology & Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium.,Brussels University Consultation Center, Vrije Universiteit Brussel, Brussel, Belgium
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9
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Mastria G, Viganò A, Corrado A, Mancini V, Pirillo C, Badini S, Petolicchio B, Toscano M, Altieri M, Delle Chiaie R, Di Piero V. Chronic Migraine Preventive Treatment by Prefrontal-Occipital Transcranial Direct Current Stimulation (tDCS): A Proof-of-Concept Study on the Effect of Psychiatric Comorbidities. Front Neurol 2021; 12:654900. [PMID: 34079513 PMCID: PMC8166222 DOI: 10.3389/fneur.2021.654900] [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: 01/17/2021] [Accepted: 03/29/2021] [Indexed: 12/26/2022] Open
Abstract
Chronic migraine (CM) is often complicated by medication overuse headache (MOH) and psychiatric comorbidities that may influence the clinical outcome. This study aimed to investigate the relationship between psychiatric comorbidities and the effect of transcranial direct current stimulation (tDCS) in patients with CM with or without MOH. We recruited 16 consecutive CM patients who had an unsatisfactory response to at least three pharmacological preventive therapies. They were treated with anodal right-prefrontal and cathodal occipital tDCS (intensity: 2 mA, time: 20 min) three times per week for 4 weeks. All patients underwent a psychopathological assessment before and after treatment, and five of them were diagnosed with bipolar disorder (BD). After treatment, all the patients showed a significant decrease of severe and overall headache days per month. Despite having a higher migraine burden at baseline, patients with CM and BD showed a significantly greater reduction of severe headaches and psychiatric symptoms. Overall, tDCS seems to be effective in the treatment of CM patients with a poor response to different classes of pharmacological therapies, whereas BD status positively influences the response of migraineurs to tDCS.
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Affiliation(s)
- Giulio Mastria
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy.,My Space Lab, Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | | | - Alessandra Corrado
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy
| | - Valentina Mancini
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy.,Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Cristina Pirillo
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy
| | - Simone Badini
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy
| | | | - Massimiliano Toscano
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy.,Department of Neurology-Fatebenefratelli Hospital, Rome, Italy
| | - Marta Altieri
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy
| | | | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy.,University Consortium for Adaptive Disorders and Head Pain-UCADH, Pavia, Italy
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10
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Ciullo V, Spalletta G, Caltagirone C, Banaj N, Vecchio D, Piras F, Piras F. Transcranial Direct Current Stimulation and Cognition in Neuropsychiatric Disorders: Systematic Review of the Evidence and Future Directions. Neuroscientist 2020; 27:285-309. [PMID: 32644874 DOI: 10.1177/1073858420936167] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been implemented in neuropsychiatric disorders characterized by cognitive impairment. However, methodological heterogeneity challenges conclusive remarks. Through a critical analysis of previous conflicting findings and in the light of current neurobiological models of pathophysiology, we qualitatively assessed the effects of tDCS in neuropsychiatric disorders that share neurobiological underpinnings, as to evaluate whether stimulation can improve cognitive deficits in patients' cohorts. We performed a systematic review of tDCS studies targeting cognitive functions in mental disorders and pathological cognitive aging. Data from 41 studies, comprising patients with diagnosis of mood disorders, schizophrenia-spectrum disorders, Alzheimer's disease (AD), and mild cognitive impairment (MCI), were included. Results indicate that tDCS has the capacity to enhance processing speed, working memory, and executive functions in patients with mood and schizophrenia-spectrum disorders. The evidence of a positive effect on general cognitive functioning and memory is either inconclusive in AD, or weak in MCI. Future directions are discussed for developing standardized stimulation protocols and for translating the technique therapeutic potential into effective clinical practice.
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Affiliation(s)
- Valentina Ciullo
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Gianfranco Spalletta
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Carlo Caltagirone
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Nerisa Banaj
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Daniela Vecchio
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Fabrizio Piras
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Federica Piras
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
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11
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van Dun K, Mitoma H, Manto M. Cerebellar Cortex as a Therapeutic Target for Neurostimulation. THE CEREBELLUM 2018; 17:777-787. [PMID: 30276522 DOI: 10.1007/s12311-018-0976-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-invasive stimulation of the cerebellum is growingly applied both in the clinic and in research settings to modulate the activities of cerebello-cerebral loops. The anatomical location of the cerebellum, the high responsiveness of the cerebellar cortex to magnetic/electrical stimuli, and the implication of the cerebellum in numerous cerebello-cerebral networks make the cerebellum an ideal target for investigations and therapeutic purposes. In this mini-review, we discuss the potentials of cerebellar neuromodulation in major brain disorders in order to encourage large-scale sham-controlled research and explore this therapeutic aid further.
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Affiliation(s)
- Kim van Dun
- Clinical and Experimental Neurolinguistics, CLIN, Vrije Universiteit Brussels, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Hiroshi Mitoma
- Medical Education Promotion Center, Tokyo Medical University, Tokyo, Japan
| | - Mario Manto
- Service de Neurologie, Médiathèque Jean Jacquy, CHU-Charleroi, Charleroi, Belgium.,Service des Neurosciences, UMons, Mons, Belgium
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12
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Dondé C, Neufeld NH, Geoffroy PA. The Impact of Transcranial Direct Current Stimulation (tDCS) on Bipolar Depression, Mania, and Euthymia: a Systematic Review of Preliminary Data. Psychiatr Q 2018; 89:855-867. [PMID: 29785673 DOI: 10.1007/s11126-018-9584-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The neurobiological basis of bipolar disorders (BD) has received increased attention and several brain regions and brain circuits have been correlated with clinical symptoms. These brain regions and circuits may represent targets for neuromodulation techniques such as transcranial Direct Current Stimulation (tDCS). We systematically reviewed the literature to explore the risks and benefits of tDCS in BD and examined all mood states. Following the PRISMA guidelines, a systematic literature search using several databases was performed from April 2002 to June 2017. From the 135 eligible studies, we retained 19 relevant articles for the systematic review, including 170 patients with BD treated by tDCS. Data from 10 studies suggest that tDCS improves depressive symptoms in BD. One case report of add-on-tDCS reported a significant positive response on manic symptoms. In 4 studies, tDCS impacted specific neurocognitive functions in euthymic patients. There is also preliminary evidence that tDCS improves neurological soft signs and sleep quality in euthymia. Side effects were predominantly transient and low-intensity, although 6 cases of hypomanic/manic affective switches have been reported. The majority of studies have been open trials with few patients. More sufficiently powered randomized controlled trials are needed to clarify the effectiveness of tDCS. Preliminary data suggests that tDCS holds promise as a treatment for BD, especially during depressive episodes. Perhaps most promising are emerging data suggesting tDCS may impact neurocognition and sleep quality in euthymia and be useful for relapse prevention.
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Affiliation(s)
- Clément Dondé
- University Lyon 1, F-69000, Villeurbanne, France. .,Centre Hospitalier Le Vinatier, CH Le Vinatier, Batiment 416, 95 boulevard Pinel, BP 300 39, 69 678 Bron Cedex, France.
| | | | - Pierre A Geoffroy
- Inserm, U1144, F-75006, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, F-75013, Paris, France.,AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475, Paris cedex 10, France.,Fondation FondaMental, 94000, Créteil, France
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13
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Abstract
Transcranial magnetic and electric stimulation of the brain are novel and highly promising techniques currently employed in both research and clinical practice. Improving or rehabilitating brain functions by modulating excitability with these noninvasive tools is an exciting new area in neuroscience. Since the cerebellum is closely connected with the cerebral regions subserving motor, associative, and affective functions, the cerebello-thalamo-cortical pathways are an interesting target for these new techniques. Targeting the cerebellum represents a novel way to modulate the excitability of remote cortical regions and their functions. This review brings together the studies that have applied cerebellar stimulation, magnetic and electric, and presents an overview of the current knowledge and unsolved issues. Some recommendations for future research are implemented as well.
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14
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Solé B, Jiménez E, Torrent C, Reinares M, Bonnin CDM, Torres I, Varo C, Grande I, Valls E, Salagre E, Sanchez-Moreno J, Martinez-Aran A, Carvalho AF, Vieta E. Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies. Int J Neuropsychopharmacol 2017; 20:670-680. [PMID: 28498954 PMCID: PMC5570032 DOI: 10.1093/ijnp/pyx032] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/08/2017] [Indexed: 12/21/2022] Open
Abstract
Over the last decade, there has been a growing appreciation of the importance of identifying and treating cognitive impairment associated with bipolar disorder, since it persists in remission periods. Evidence indicates that neurocognitive dysfunction may significantly influence patients' psychosocial outcomes. An ever-increasing body of research seeks to achieve a better understanding of potential moderators contributing to cognitive impairment in bipolar disorder in order to develop prevention strategies and effective treatments. This review provides an overview of the available data from studies examining treatments for cognitive dysfunction in bipolar disorder as well as potential novel treatments, from both pharmacological and psychological perspectives. All these data encourage the development of further studies to find effective strategies to prevent and treat cognitive impairment associated with bipolar disorder. These efforts may ultimately lead to an improvement of psychosocial functioning in these patients.
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Affiliation(s)
- Brisa Solé
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Esther Jiménez
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Carla Torrent
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Maria Reinares
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Caterina del Mar Bonnin
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Imma Torres
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Cristina Varo
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Iria Grande
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Elia Valls
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Estela Salagre
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Jose Sanchez-Moreno
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Anabel Martinez-Aran
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - André F Carvalho
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
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Ammann C, Spampinato D, Márquez-Ruiz J. Modulating Motor Learning through Transcranial Direct-Current Stimulation: An Integrative View. Front Psychol 2016; 7:1981. [PMID: 28066300 PMCID: PMC5179543 DOI: 10.3389/fpsyg.2016.01981] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 12/05/2016] [Indexed: 02/05/2023] Open
Abstract
Motor learning consists of the ability to improve motor actions through practice playing a major role in the acquisition of skills required for high-performance sports or motor function recovery after brain lesions. During the last decades, it has been reported that transcranial direct-current stimulation (tDCS), consisting in applying weak direct current through the scalp, is able of inducing polarity-specific changes in the excitability of cortical neurons. This low-cost, painless and well-tolerated portable technique has found a wide-spread use in the motor learning domain where it has been successfully applied to enhance motor learning in healthy individuals and for motor recovery after brain lesion as well as in pathological states associated to motor deficits. The main objective of this mini-review is to offer an integrative view about the potential use of tDCS for human motor learning modulation. Furthermore, we introduce the basic mechanisms underlying immediate and long-term effects associated to tDCS along with important considerations about its limitations and progression in recent years.
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Affiliation(s)
- Claudia Ammann
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medical Institution Baltimore, MD, USA
| | - Danny Spampinato
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medical Institution Baltimore, MD, USA
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16
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van Dun K, Bodranghien FCAA, Mariën P, Manto MU. tDCS of the Cerebellum: Where Do We Stand in 2016? Technical Issues and Critical Review of the Literature. Front Hum Neurosci 2016; 10:199. [PMID: 27242469 PMCID: PMC4862979 DOI: 10.3389/fnhum.2016.00199] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/19/2016] [Indexed: 01/23/2023] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) is an up-and-coming electrical neurostimulation technique increasingly used both in healthy subjects and in selected groups of patients. Due to the high density of neurons in the cerebellum, its peculiar anatomical organization with the cortex lying superficially below the skull and its diffuse connections with motor and associative areas of the cerebrum, the cerebellum is becoming a major target for neuromodulation of the cerebellocerebral networks. We discuss the recent studies based on cerebellar tDCS with a focus on the numerous technical and open issues which remain to be solved. Our current knowledge of the physiological impacts of tDCS on cerebellar circuitry is criticized. We provide a comparison with transcranial Alternating Current Stimulation (tACS), another promising transcranial electrical neurostimulation technique. Although both tDCS and tACS are becoming established techniques to modulate the cerebellocerebral networks, it is surprising that their impacts on cerebellar disorders remains unclear. A major reason is that the literature lacks large trials with a double-blind, sham-controlled, and cross-over experimental design in cerebellar patients.
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Affiliation(s)
- Kim van Dun
- Clinical and Experimental Neurolinguistics, Vrije Universiteit Brussel Brussels, Belgium
| | - Florian C A A Bodranghien
- Unité d'Etude du Mouvement, Laboratoire de Neurologie Expérimentale, Université libre de Bruxelles (ULB) Brussels, Belgium
| | - Peter Mariën
- Clinical and Experimental Neurolinguistics, Vrije Universiteit BrusselBrussels, Belgium; Department of Neurology and Memory Clinic, ZNA Middelheim General HospitalAntwerp, Belgium
| | - Mario U Manto
- Unité d'Etude du Mouvement, Laboratoire de Neurologie Expérimentale, Université libre de Bruxelles (ULB)Brussels, Belgium; Service des Neurosciences, Université de MonsMons, Belgium
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Bersani FS, Minichino A, Fattapposta F, Bernabei L, Spagnoli F, Mannarelli D, Francesconi M, Pauletti C, Corrado A, Vergnani L, Taddei I, Biondi M, Delle Chiaie R. Prefrontocerebellar transcranial direct current stimulation increases amplitude and decreases latency of P3b component in patients with euthymic bipolar disorder. Neuropsychiatr Dis Treat 2015; 11:2913-7. [PMID: 26640377 PMCID: PMC4657792 DOI: 10.2147/ndt.s91625] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Neurocognitive impairments have been observed in patients with bipolar disorder (BD) even during the euthymic phase of the disease, potentially representing trait-associated rather than state-associated characteristics of the disorder. In the present study, we used transcranial direct current stimulation (tDCS) applied to cerebellar and prefrontal cortices to improve the neurophysiological performances of patients with euthymic BD. METHODS Twenty-five outpatients with BD underwent open-label prefrontocerebellar tDCS for 3 consecutive weeks. Neurophysiological performances were assessed through the examination of the P3b and P3a subcomponents of P300 event-related potential at baseline and after stimulation. RESULTS Compared to baseline, P3b component after tDCS showed significantly higher amplitude and shorter latency (latency: Fz P=0.02, Cz P=0.03, and Pz P=0.04; amplitude: Fz P=0.24, Cz P=0.02, and Pz P=0.35). CONCLUSION In our sample of patients with euthymic BD, concomitant prefrontoexcitatory and cerebellar-inhibitory modulations led to improved brain information processing stream. This improvement may at least partially result from neuroplastic modulation of prefrontocerebellar circuitry activity.
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Affiliation(s)
| | - Amedeo Minichino
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Laura Bernabei
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Francesco Spagnoli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Daniela Mannarelli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Marta Francesconi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Caterina Pauletti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Alessandra Corrado
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Lucilla Vergnani
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Ines Taddei
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Massimo Biondi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Roberto Delle Chiaie
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
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