Long-term Effect of Multichannel tDCS Protocol in Patients with Central Cortex Epilepsies Associated with Epilepsia Partialis Continua

Epilepsia partialis continua (EPC) is a rare type of focal motor status epilepticus that causes continuous muscle jerking in a specific part of the body. Experiencing this type of seizure, along with other seizure types, such as focal motor seizures and focal to bilateral tonic-clonic seizures, can result in a disabling situation. Non-invasive brain stimulation methods like transcranial direct current stimulation (tDCS) show promise in reducing seizure frequency (SF) when medications are ineffective. However, research on tDCS for EPC and related seizures is limited. We evaluated personalized multichannel tDCS in drug-resistant EPC of diverse etiologies for long-term clinical efficacy We report three EPC patients undergoing a long-term protocol of multichannel tDCS. The patients received several cycles (11, 9, and 3) of five consecutive days of stimulation at 2 mA for 2 × 20 min, targeting the epileptogenic zone (EZ), including the central motor cortex with cathodal electrodes. The primary measurement was SF changes. In three cases, EPC was due to Rasmussen's Encephalitis (case 1), focal cortical dysplasia (case 2), or remained unknown (case 3). tDCS cycles were administered over 6 to 22 months. The outcomes comprised a reduction of at least 75% in seizure frequency for two patients, and in one case, a complete cessation of severe motor seizures. However, tDCS had no substantial impact on the continuous myoclonus characterizing EPC. No serious side effects were reported. Long-term application of tDCS cycles is well tolerated and can lead to a considerable reduction in disabling seizures in patients with various forms of epilepsy with EPC.

Noninvasive Brain Stimulation & Space Exploration: Opportunities and Challenges

As NASA prepares for longer space missions aiming for the Moon and Mars, astronauts' health and performance are becoming a central concern due to the threats associated with galactic cosmic radiation, unnatural gravity fields, and life in extreme environments. In space, the human brain undergoes functional and structural changes related to fluid shift and changes in intracranial pressure. Behavioral abnormalities, such as cognitive deficits, sleep disruption, and visuomotor difficulties, as well as psychological effects, are also an issue. We discuss opportunities and challenges of noninvasive brain stimulation (NiBS) methods - including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES) - to support space exploration in several ways. NiBS includes safe and portable techniques already applied in a wide range of cognitive and motor domains, as well as therapeutically. NiBS could be used to enhance in-flight performance, supporting astronauts during pre-flight Earth-based training, as well as to identify biomarkers of post-flight brain changes for optimization of rehabilitation/compensatory strategies. We review these NiBS techniques and their effects on brain physiology, psychology, and cognition.

Reduction of intratumoral brain perfusion by noninvasive transcranial electrical stimulation

Malignant brain neoplasms have a poor prognosis despite aggressive treatments. Animal models and evidence from human bodily tumors reveal that sustained reduction in tumor perfusion via electrical stimulation promotes tumor necrosis, therefore possibly representing a therapeutic option for patients with brain tumors. Here, we demonstrate that transcranial electrical stimulation (tES) allows to safely and noninvasively reduce intratumoral perfusion in humans. Selected patients with glioblastoma or metastasis underwent tES, while perfusion was assessed using magnetic resonance imaging. Multichannel tES was applied according to personalized biophysical modeling, to maximize the induced electrical field over the solid tumor mass. All patients completed the study and tolerated the procedure without adverse effects, with tES selectively reducing the perfusion of the solid tumor. Results potentially open the door to noninvasive therapeutic interventions in brain tumors based on stand-alone tES or its combination with other available therapies.

Detection of generalized synchronization using echo state networks

Generalized synchronization between coupled dynamical systems is a phenomenon of relevance in applications that range from secure communications to physiological modelling. Here, we test the capabilities of reservoir computing and, in particular, echo state networks for the detection of generalized synchronization. A nonlinear dynamical system consisting of two coupled Rössler chaotic attractors is used to generate temporal series consisting of time-locked generalized synchronized sequences interleaved with unsynchronized ones. Correctly tuned, echo state networks are able to efficiently discriminate between unsynchronized and synchronized sequences even in the presence of relatively high levels of noise. Compared to other state-of-the-art techniques of synchronization detection, the online capabilities of the proposed Echo State Network based methodology make it a promising choice for real-time applications aiming to monitor dynamical synchronization changes in continuous signals.

Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines

Low intensity transcranial electrical stimulation (TES) in humans, encompassing transcranial direct current (tDCS), transcutaneous spinal Direct Current Stimulation (tsDCS), transcranial alternating current (tACS), and transcranial random noise (tRNS) stimulation or their combinations, appears to be safe. No serious adverse events (SAEs) have been reported so far in over 18,000 sessions administered to healthy subjects, neurological and psychiatric patients, as summarized here. Moderate adverse events (AEs), as defined by the necessity to intervene, are rare, and include skin burns with tDCS due to suboptimal electrode-skin contact. Very rarely mania or hypomania was induced in patients with depression (11 documented cases), yet a causal relationship is difficult to prove because of the low incidence rate and limited numbers of subjects in controlled trials. Mild AEs (MAEs) include headache and fatigue following stimulation as well as prickling and burning sensations occurring during tDCS at peak-to-baseline intensities of 1-2mA and during tACS at higher peak-to-peak intensities above 2mA. The prevalence of published AEs is different in studies specifically assessing AEs vs. those not assessing them, being higher in the former. AEs are frequently reported by individuals receiving placebo stimulation. The profile of AEs in terms of frequency, magnitude and type is comparable in healthy and clinical populations, and this is also the case for more vulnerable populations, such as children, elderly persons, or pregnant women. Combined interventions (e.g., co-application of drugs, electrophysiological measurements, neuroimaging) were not associated with further safety issues. Safety is established for low-intensity 'conventional' TES defined as <4mA, up to 60min duration per day. Animal studies and modeling evidence indicate that brain injury could occur at predicted current densities in the brain of 6.3-13A/m2 that are over an order of magnitude above those produced by tDCS in humans. Using AC stimulation fewer AEs were reported compared to DC. In specific paradigms with amplitudes of up to 10mA, frequencies in the kHz range appear to be safe. In this paper we provide structured interviews and recommend their use in future controlled studies, in particular when trying to extend the parameters applied. We also discuss recent regulatory issues, reporting practices and ethical issues. These recommendations achieved consensus in a meeting, which took place in Göttingen, Germany, on September 6-7, 2016 and were refined thereafter by email correspondence.

The relationship between transcranial current stimulation electrode montages and the effect of the skull orbital openings

Due to its low electric conductivity, the skull has a major impact on the electric field distribution in the brain in transcranial current stimulation (tCS). However, the skull has several openings that are filled with higher conductivity soft tissues, and through which a significant fraction of the injected current may pass. We show that current entering the brain via the orbital openings increases the electric field intensity in the cortical regions near the orbit. Furthermore, this depends on the how far electrodes are placed from the orbital openings.

Modeling the electric field induced in a high resolution realistic head model during transcranial current stimulation

Much of our knowledge about the electric field distribution in transcranial current stimulation (tCS) still relies on results obtained from layered spherical head models. In this work we created a high resolution finite element model of a human head by segmentation of MRI images, and paid particular attention to the representation of the cortical sheet. This model was then used to calculate the electric field induced by two electrodes: an anode placed above the left motor cortex, and a cathode placed over the right eyebrow. The results showed that the maxima of the current density appear located on localized hotspots in the bottom of sulci and not on the cortical surface as would be expected from spherical models. This also applies to the components of the current density normal and tangential to the cortical surface. These results show that such highly detailed head models are needed to correctly predict the effects of tCS on cortical neurons.

Mismatch negativity impairment associated with alcohol consumption in chronic alcoholics: A scalp current density study

Previous studies, based on amplitude and latency measurements of auditory event-related brain potentials, yielded inconclusive results about the status of mismatch negativity (MMN) in chronic alcoholics. The present study explores scalp current density (SCD) dynamics during MMN latency range in alcoholics, and correlates electrical SCD results with clinical data of the patients. SCD was computed from 30 electrodes in 16 abstinent chronic alcoholics and 16 healthy control volunteers in a paradigm on MMN elicited by duration changes. Reduced activity was observed in left frontal and right anterior and posterior temporal areas during MMN in alcoholics. Alcohol consumption correlated negatively with SCD intensity in these regions. Delayed activation was observed in the left posterior temporal area in the patients. Alcohol abstinence duration correlated positively with SCD intensity in this region. These results point to an impairment of automatic brain processing mechanisms associated with auditory change detection in chronic alcoholism. The present results suggest a reorganization of the computational neurodynamics of automatic auditory change detection linked to the amount of alcohol consumed in abstinent chronic alcoholics.

Combined ICA-LORETA analysis of mismatch negativity

A major challenge for neuroscience is to map accurately the spatiotemporal patterns of activity of the large neuronal populations that are believed to underlie computing in the human brain. To study a specific example, we selected the mismatch negativity (MMN) brain wave (an event-related potential, ERP) because it gives an electrophysiological index of a "primitive intelligence" capable of detecting changes, even abstract ones, in a regular auditory pattern. ERPs have a temporal resolution of milliseconds but appear to result from mixed neuronal contributions whose spatial location is not fully understood. Thus, it is important to separate these sources in space and time. To tackle this problem, a two-step approach was designed combining the independent component analysis (ICA) and low-resolution tomography (LORETA) algorithms. Here we implement this approach to analyze the subsecond spatiotemporal dynamics of MMN cerebral sources using trial-by-trial experimental data. We show evidence that a cerebral computation mechanism underlies MMN. This mechanism is mediated by the orchestrated activity of several spatially distributed brain sources located in the temporal, frontal, and parietal areas, which activate at distinct time intervals and are grouped in six main statistically independent components.

[Oxygen therapy via Ventimask. Personal cases]

Eleven patients suffering from seriously hypoxaemic chronic respiratory insufficiency with slight hypercapnia have been assessed. A comparison between the results obtained with continuous oxygen therapy carried out with a Ventury mask and that done with the Ventimask was made in the case of each patient. Distribution of O2 with the Ventimask made it possible to obtain higher average pO2 levels than with the Ventury mask.

[A rapid method for the isolation of Salmonellae from faeces (author's transl)]

A rapid and simple method for detecting Salmonellae in faeces was developed. It was based on the motility of Salmonellae through a semi-solid medium in a U-tube. The migration of other intestinal bacteria was retarded by means of a magnesium salt concentration. 474 stool specimens were examined for Salmonellae in parallel with the usual isolation method. A total of 39 Salmonella strains were isolated, 37 (94.9%) by means of the selective migration procedure, 26 (66.7%) when the routine method was applied. Two strains of patients in chemo-therapy were missed by the rapid method, which was moreover inefficient in detecting S. typhi, due to its slow motility. However, the rapid method is recommended in addition to conventional mediums in screening of carriers for its higher frequency of positive isolations compared with multistep procedure (+27.3%).

[Microbiology of chronic lung diseases in children (author's transl)]

The bacterial flora was studied in the bronchial, pharyngeal secretions and sputum of 80 children with Cystic Fibrosis (CF) and of 21 children with other chronic lung diseases, treated at the Pediatric Clinic (Respiratory Unit), University of Genoa. Staphylococcus aureus was found in 52% of patients, Pseudomonas aeruginosa in 48%, Proteus in 5%. According to the age, the patients have been distinguished into four groups; in the 6-10 and 11-15 year-old group Staphylococcus aureus was the commonest pathogen isolated, while Pseudomonas aeruginosa was found much more commonly in the 16-20 year-old group. Details are given of antibiotic-sensitivity for single strains grown. Intensive care programs, based on specific antibiotic-sensitivity, for in-patients and out-patients, are reported: positive results in treatment courses with Gentamicin, Cephalosporins and Tobramycin are presented.