Polarity-Specific Cortical Effects of Transcranial Direct Current Stimulation in Primary Somatosensory Cortex of Healthy Humans

Therapeutic benefits of noninvasive somatosensory cortex stimulation on cortical plasticity and somatosensory function: a systematic review

Optimal limb coordination requires efficient transmission of somatosensory information to the sensorimotor cortex. The primary somatosensory cortex (S1) is frequently damaged by stroke, resulting in both somatosensory and motor impairments. Noninvasive brain stimulation (NIBS) to the primary motor cortex is thought to induce neural plasticity that facilitates neurorehabilitation. Several studies have also examined if NIBS to the S1 can enhance somatosensory processing as assessed by somatosensory-evoked potentials (SEPs) and improve behavioral task performance, but it remains uncertain if NIBS can reliably modulate S1 plasticity or even whether SEPs can reflect this plasticity. This systematic review revealed that NIBS has relatively minor effects on SEPs or somatosensory task performance, but larger early SEP changes after NIBS can still predict improved performance. Similarly, decreased paired-pulse inhibition in S1 post-NIBS is associated with improved somatosensory performance. However, several studies still debate the role of inhibitory function in somatosensory performance after NIBS in terms of the direction of the change (that, disinhibition or inhibition). Altogether, early SEP and paired-pulse inhibition (particularly inter-stimulus intervals of 30-100 ms) may become useful biomarkers for somatosensory deficits, but improved NIBS protocols are required for therapeutic applications.

Combined effect of hydrotherapy and transcranial direct-current stimulation on children with cerebral palsy: A protocol for a randomized controlled trial

BACKGROUND

Cerebral palsy (CP) is a neurodevelopmental disorder caused by a brain injury resulting in poor coordination and motor control deficits, which is one of the most common physical disabilities in children. CP brings a heavy burden on families and society and becomes a significant public health issue. In recent years, hydrotherapy, and transcranial direct current stimulation (tDCS) as a physical therapy for CP is developing rapidly. When hydrotherapy and tDCS are used to treat separately, it has positive therapeutic effect in children with CP. The development of new therapies in combination with physical rehabilitation approaches is critical to optimize functional outcomes. tDCS has attracted interest in this context, because of significant functional improvements have been demonstrated in individuals with brain injuries after a short period of cerebral stimulation. Since the onset of this work, tDCS has been used in combination with constraint-induced therapy, virtual reality therapy to potentiate the treatment effect. Up to now, there are no studies on the effect of a combined application of hydrotherapy and tDCS in children with CP. We will conduct a 2-arm parallel clinical trial to investigate the effect of a combined application of tDCS and hydrotherapy.

METHODS AND ANALYSIS

This study is an outcome assessor and data analyst-blinded, randomized, controlled superiority trial during the period from October 2021 to December 2023. CP patients meeting the inclusion criteria will be allocated in a 1:1 ratio into the treatment group (hydrotherapy plus tDCS), or the control group (treatment as usual). All participants will receive 30 sessions of treatment over 10 weeks. The primary outcomes will be the difference in the Gross Motor Function Assessment and Pediatric Balance Scale during rest and activity. The secondary outcomes will be the difference in adverse effects between the control and treatment groups.

CONCLUSIONS

This study aims to estimate the efficacy of a combined application of tDCS and hydrotherapy in patients with CP.

TRIAL REGISTRATION

This study protocol was registered in Chinese ClinicalTrials.gov, ID: ChiCTR2100047946.

α-tACS over the somatosensory cortex enhances tactile spatial discrimination in healthy subjects with low alpha activity

INTRODUCTION

Spontaneous oscillations in the somatosensory cortex, especially of the alpha (8 - 14 Hz) and gamma (60 - 80 Hz) frequencies, affect tactile perception; moreover, these oscillations can be selectively modulated by frequency-matched transcranial alternating current stimulation (tACS) on the basis of ongoing oscillatory brain activity. To examine whether tACS can actually improve tactile perception via alpha and gamma modulation, we measured the effects of 10-Hz and 70-Hz tACS (α- and γ-tACS) on the left somatosensory cortex on right-finger tactile spatial orientation discrimination, and the associations between performance changes and individual alpha and gamma activities.

METHODS

Fifteen neurologically healthy subjects were recruited into this study. Electroencephalography (EEG) was performed before the first day, to assess the normal alpha- and gamma-activity levels. A grating orientation discrimination task was performed before and during 10-Hz and 70-Hz tACS.

RESULTS

The 10-Hz tACS protocol decreased the grating orientation discrimination threshold, primarily in subjects with low alpha event-related synchronization (ERS). In contrast, the 70-Hz tACS had no effect on the grating orientation discrimination threshold.

CONCLUSIONS

This study showed that 10-Hz tACS can improve tactile orientation discrimination in subjects with low alpha activity. Alpha-frequency tACS may help identify the contributions of these oscillations to other neurophysiological and pathological processes.

Modulation of inhibitory function in the primary somatosensory cortex and temporal discrimination threshold induced by acute aerobic exercise

Acute aerobic exercise beneficially affects brain function. The effect of acute aerobic exercise on the inhibitory mechanism of the primary somatosensory cortex (S1) and somatosensory function remains unclear. We investigated whether acute aerobic exercise modulates S1 inhibitory function and somatosensory function. In Experiment 1, we measured somatosensory evoked potentials (SEP) and paired-pulse inhibition (PPI) in 15 healthy right-handed participants. The right median nerve underwent electrical stimulation (ES). Interstimulus intervals were 5 ms, 30 ms, and 100 ms. In Experiment 2, we assessed the somatosensory function by using a somatosensory temporal discrimination task. Single or paired ES was applied to the distal phalanx of the right index finger. Both the experiments involved three sessions: 20 min of moderate-intensity exercise, 30 min of low-intensity exercise, and 30 min of seated rest. Before and after each session, PPI and somatosensory temporal discrimination task performance were measured. The N20 latency was significantly shortened immediately after moderate exercise. The SEP amplitude was not modulated in any session. The PPI at 30 ms (PPI_30ms) significantly decreased 20 min after moderate exercise, whereas the PPI at 5 ms (PPI_5ms) and PPI at 100 ms (PPI_100ms) did not change. The 50% and 75% thresholds and reaction time did not improve in any session. We found negative relationships between the change in PPI_5ms and the change in the 75% threshold under low-intensity exercise condition. Thus, acute aerobic exercise modulated S1 inhibitory function depending on exercise intensity. The exercise-induced change in PPI was associated with the change in temporal discrimination.

Comparison of transcranial electrical stimulation regimens for effects on inhibitory circuit activity in primary somatosensory cortex and tactile spatial discrimination performance

Transcranial electrical stimulation (tES) can be used to modulate inhibitory circuits in primary somatosensory cortex, resulting in improved somatosensory function. However, efficacy may depend on the specific stimulus modality and patterns. For instance, transcranial alternating current stimulation (tACS), transcranial random noise stimulation (tRNS), and transcranial pulsed current stimulation (tPCS) were found to stably and effectively modulate neuronal excitability, while anodal transcranial direct current stimulation (tDCS) appeared less effective overall but with substantial response heterogeneity among subjects. Therefore, we compared the effects of tES applied to primary somatosensory cortex on somatosensory evoked potential paired-pulse depression (SEP-PPD) and tactile discrimination performance in 17 neurologically healthy subjects. In Experiment 1, somatosensory evoked potential N20/P25_SEP-PPD, N20_SEP-PPD, and P25_SEP-PPD responses were assessed before and immediately after anodal tDCS, tACS (stimulation frequency, 140 Hz), tRNS (stimulation frequency, 0.1-640 Hz), anodal tPCS (pulse width, 50 ms; inter-pulse interval, 5 ms), and sham stimulation applied to primary somatosensory cortex. In Experiment 2, a grating orientation task (GOT) was performed before and immediately after the same anodal tDCS, tRNS, anodal tPCS, and sham stimulation regimens. Anodal tDCS and anodal tPCS decreased N20_SEP-PPD, and tRNS increased the first N20 SEP amplitude. Furthermore, tRNS and anodal tPCS decreased GOT discrimination threshold (improved performance). These results suggest that tRNS and anodal tPCS can improve sensory perception by modulating neuronal activity in primary somatosensory cortex.

Modulation of the rubber hand illusion by transcranial direct current stimulation over the contralateral somatosensory cortex

In the rubber hand illusion (RHI), illusory bodily ownership is induced by synchronous touch of a participant's hidden hand and a visible surrogate. This paradigm allows investigating how the brain resolves conflicting multisensory evidence during perceptual inference. Previous studies suggest that the conflict between visual and proprioceptive information preceding the RHI is solved by attenuation of the somatosensory input. To investigate whether excitability-decreasing transcranial direct current stimulation (cathodal tDCS) over the primary somatosensory cortex may enhance the RHI, thirty healthy subjects underwent RHI without (baseline) and during tDCS. Each subject received cathodal, anodal, and sham stimulation at independent sessions on three separate days. The RHI paradigm was applied at six interval distances between the real and artificial hand. Occurrence of the RHI was evaluated by a questionnaire (illusion score) and the perceived hand misplacement (relative drift). Compared to sham, neither cathodal, nor anodal tDCS induced significant changes of the illusion score. However, cathodal tDCS was associated with significantly higher illusion scores compared to anodal stimulation. The relative drift was comparable between stimulation modes. Our findings point to a differential impact of cathodal vs. anodal tDCS over the somatosensory region on RHI perception. This may indicate that an attenuation - in contrast to an enhancement - of somatosensory precision might pave the way for the integration of an artificial limb into one's body schema.

Paradoxical, causal effects of sensory gain modulation on motor inhibitory control - a tDCS, EEG-source localization study

Response inhibition is a key component of executive functioning, but the role of perceptual processes has only recently been focused. Although the interrelation of incoming information and resulting behavioural (motor) effects is well-known to depend on gain control mechanisms, the causal role of sensory gain modulation for response inhibition is elusive. We investigate it using a somatosensory response inhibition (Go/Nogo) task and examine the effects of parietal (somatosensory) cathodal and sham tDCS stimulation on a behavioural and neurophysiological level. For the latter, we combine event-related potential (ERP) and source localization analyses. Behavioural results reveal that cathodal stimulation leads to superior inhibition performance as compared to sham stimulation depending on the intensity of tDCS stimulation. The neurophysiological data show that an early (perceptual) subprocess of the Nogo-N2 ERP-component is differentially modulated by the type of stimulation but not a later (response-related) Nogo-N2 subcomponent. Under cathodal stimulation, the early N2 amplitude is reduced and the right inferior frontal gyrus (BA45) is less active. Cathodal tDCS likely enhances inhibition performance via decreasing the efficiency of gain control and the impact of sensory stimuli to trigger prepotent responses. Thereby, response inhibition processes, associated with structures of the response inhibition network, become less demanded.

Dose response of somatosensory cortex repeated anodal transcranial direct current stimulation on vibrotactile detection: a randomized sham-controlled trial

This randomized sham-controlled trial investigated anodal transcranial direct current stimulation (tDCS) over the somatosensory cortex contralateral to hand dominance for dose-response (1 mA, 20 min × 5 days) effects on vibrotactile detection thresholds (VDT). VDT was measured before and after tDCS on days 1, 3, and 5 for low- (30 Hz) and high-frequency (200 Hz) vibrations on the dominant and nondominant hands in 29 healthy adults (mean age = 22.86 yr; 15 men, 14 women). Only the dominant-hand 200-Hz VDT displayed statistically significant medium effect size improvement for mixed-model analysis of variance time-by-group interaction for active tDCS compared with sham. Post hoc contrasts were statistically significant for dominant-hand 200-Hz VDT on day 5 after tDCS compared with day 1 before tDCS, day 1 after tDCS, and day 3 before tDCS. There was a linear dose-response improvement with dominant-hand 200-Hz VDT mean difference decreasing from day 1 before tDCS peaking at -15.5% (SD = 34.9%) on day 5 after tDCS. Both groups showed learning effect trends over time for all VDT test conditions, but only the nondominant-hand 30-Hz VDT was statistically significant ( P = 0.03), although post hoc contrasts were nonsignificant after Šidák adjustment. No adverse effects for tDCS were reported. In conclusion, anodal tDCS at 1 mA, 20 min × 5 days on the dominant sensory cortex can modulate a linear improvement of dominant-hand high-frequency VDT but not low-frequency or nondominant-hand VDT. NEW & NOTEWORTHY Repeated weak anodal transcranial direct current stimulation (1 mA, 20 min) on the dominant sensory cortex provides linear improvement in dominant-hand high-frequency vibration detection thresholds. No effects were observed for low-frequency or nondominant-hand vibration detection thresholds.

Transcranial Magnetic and Direct Current Stimulation in Children

Promising results in adult neurologic and psychiatric disorders are driving active research into transcranial brain stimulation techniques, particularly transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), in childhood and adolescent syndromes. TMS has realistic utility as an experimental tool tested in a range of pediatric neuropathologies such as perinatal stroke, depression, Tourette syndrome, and autism spectrum disorder (ASD). tDCS has also been tested as a treatment for a number of pediatric neurologic conditions, including ASD, attention-deficit/hyperactivity disorder, epilepsy, and cerebral palsy. Here, we complement recent reviews with an update of published TMS and tDCS results in children, and discuss developmental neuroscience considerations that should inform pediatric transcranial stimulation.