Transcranial direct current stimulation modulates motor responses evoked by repetitive transcranial magnetic stimulation

Timing Matters: Preconditioning Effects of Cathodal Transcranial Direct Current Stimulation on Intermittent Theta-Burst Stimulation-Induced Neuroplasticity in the Primary Motor Cortex

BACKGROUND

Recent advances have highlighted the interplay between intermittent theta-burst stimulation (iTBS) and transcranial direct current stimulation (tDCS) in neuroplasticity modulation. However, the synergistic potential of these modalities in optimizing plasticity, particularly with cathodal tDCS preconditioning before iTBS, remains poorly understood.

OBJECTIVE

This study examined the effects of cathodal high-definition tDCS (HD-tDCS) preconditioning on iTBS-induced neuroplasticity in the primary motor cortex at different timing intervals.

MATERIALS AND METHODS

Twenty healthy participants underwent four stimulation sessions in a randomized cross-over design, receiving iTBS either immediately or at 10-minute and 30-minute intervals after cathodal HD-tDCS preconditioning, in addition to a control session with iTBS immediately after sham HD-tDCS. Motor evoked potentials (MEPs) were measured at baseline and 5, 10, 15, and 30 minutes after iTBS to assess changes in neuroplasticity. Each session was separated by ≥one week to prevent carry-over effects.

RESULTS

Compared with sham sessions, immediate cathodal HD-tDCS preconditioning significantly enhanced MEPs across all measured intervals after iTBS, with sustained neuroplasticity persisting for up to 30 minutes. Immediate preconditioning produced significant MEP enhancements at 5 and 10 minutes when compared with the 30-minute delayed condition.

CONCLUSIONS

The effectiveness of cathodal tDCS preconditioning in enhancing iTBS-induced neuroplasticity decreased with increasing intervals between tDCS and iTBS application. These findings highlight the essential role of precise timing in tDCS preconditioning for maximizing the neuroplastic effects of iTBS and offer valuable insights for optimizing neurorehabilitation protocols.

Protocols for inducing homeostatic plasticity reflected in the corticospinal excitability in healthy human participants: A systematic review and meta-analysis

Homeostatic plasticity complements synaptic plasticity by stabilising neural activity within a physiological range. In humans, homeostatic plasticity is investigated using two blocks of non-invasive brain stimulation (NIBS) with an interval without stimulation between blocks. The aim of this systematic review and meta-analysis was to investigate the effect of homeostatic plasticity induction protocols on motor evoked potentials (MEP) in healthy participants. Four databases were searched (Medline, Scopus, Embase and Cochrane library). Studies describing the application of two blocks of NIBS of the primary motor cortex with an interval of no stimulation between blocks reporting changes in corticospinal excitability by MEP amplitude were included. Thirty-seven reports with 55 experiments (700 participants) were included. Study quality was considered poor overall, with heterogeneity in study size, sample and designs. Two blocks of excitatory stimulation at the primary motor cortex produced a homeostatic response (decreased MEP) between 0 and 30 min post-protocols, when compared with a single stimulation block. Two blocks of inhibitory stimulation at the primary motor cortex using interval duration of 10 min or less produced a homeostatic response (increased MEP) between 0 and 30 min post-protocols, when compared with a single stimulation block. There were no differences in MEPs when compared with baseline MEPs. In conclusion, homeostatic plasticity induction using two blocks of NIBS with an interval of 10 min or less without stimulation between blocks produces a homeostatic response up to 30 min post-protocol. Improvements in participant selection, sample sizes and protocols of NIBS techniques are needed.

Effects of transcranial direct current stimulation over right posterior parietal cortex on attention function in healthy young adults

Attention involves three distinct networks for alerting, orienting, and executive control. Interventions targeting the specific attentional networks remain lacking. Transcranial direct current stimulation (tDCS) has been shown to modulate cortical excitability, which potentially serves as an interventional tool to treat individuals with attention impairment. The purpose of this study was to examine the effects of applying tDCS over the right posterior parietal cortex (PPC) on the performance of the three attentional networks. Twenty-six healthy young adults performed the Attention Network Test before and after anodal or sham tDCS stimulation over the right PPC. The alerting, orienting, and executive effects were assessed before and after the stimulation. The results demonstrated that the orienting effect was significantly improved after real tDCS relative to sham, whereas the alerting and executive control effects remained unaffected. Consistent with previous clinical and functional imaging studies, this suggests that the right PPC is actively engaged with the spatial orienting of attention.

Patient-delivered tDCS on chronic neuropathic pain in prior responders to TMS (a randomized controlled pilot study)

Background

Successful response to repetitive transcranial magnetic stimulation (rTMS) of the motor cortex requires continued maintenance treatments. Transcranial Direct Current Stimulation (tDCS) may provide a more convenient alternative.

Methods

This pilot study aimed to examine the feasibility of a randomized, double-blind, double-crossover pilot study for patients to self-administer tDCS motor cortex stimulation for 20 minutes/day over five consecutive days. Primary outcomes were as follows: usability of patient-administered tDCS, compliance with device, recruitment, and retention rates. Secondary outcomes were as follows: effect on overall pain levels and quality of life via Short Form-36 anxiety and depression via Hospital Anxiety and Depression Scale, and Mini-Mental State scores.

Results

A total of 24 subjects with neuropathic pain, who had previously experienced rTMS motor cortex stimulation (13 with reduction in pain scores, 11 nonresponders) were recruited at the Pain Research Institute, Fazakerley, UK. A total of 21 subjects completed the study. Recruitment rate was 100% but retention rate was only 87.5%. All patients reported satisfactory usability of the tDCS device. No significant difference was shown between Sham vs Anodal (−0.16, 95% CI: −0.43 to 0.11) P=0.43, Sham vs Cathodal (0.11, 95% CI: −0.16 to 0.37) P=0.94, or Cathodal vs Anodal (−0.27, 95% CI: −0.54 to 0.00) P=0.053 treatments. Furthermore, no significant changes were demonstrated in anxiety, depression, or quality of life measurements. The data collected to estimate sample size for a definitive study suggested that the study’s sample size was already large enough to detect a change of 15% in pain levels at 90% power for the overall group of 21 patients.

Conclusion

This study did not show a beneficial effect of tDCS in this group of patients and does not support the need for a larger definitive study using the same experimental paradigm.

Trial registration

ISRCTN56839387

Facilitative effects of VNS on the motor threshold: implications for its antidepressive mode of action?

In the present study, the effects of vagus nerve stimulation (VNS) on the resting motor threshold (rMT) of patients treated with repetitive transcranial magnetic stimulation were evaluated. Patients showed a significant decrease in the rMT during VNS-on stimulation. VNS was the only significant factor affecting rMT changes and did not appear to be a static variable. Further studies should focus on the effect of VNS on neural neurogenesis in depressive disorders, and the effects of other treatment options for major depressive disorder on the rMT should also be determined.

Direct electrical stimulation of the somatosensory cortex in humans using electrocorticography electrodes: a qualitative and quantitative report

OBJECTIVE

Recently, electrocorticography-based brain-computer interfaces have been successfully used to translate cortical activity into control signals for external devices. However, the utility of such devices would be greatly enhanced by somatosensory feedback. Direct stimulation of somatosensory cortex evokes sensory perceptions, and is thus a promising option for closing the loop. Before this can be implemented in humans it is necessary to evaluate how changes in stimulus parameters are perceived and the extent to which they can be discriminated.

APPROACH

Electrical stimulation was delivered to the somatosensory cortex of human subjects implanted with electrocorticography grids. Subjects were asked to discriminate between stimuli of different frequency and amplitude as well as to report the qualitative sensations elicited by the stimulation.

MAIN RESULTS

In this study we show that in humans implanted with electrocorticography grids, variations in the amplitude or frequency of cortical electrical stimulation produce graded variations in percepts. Subjects were able to reliably distinguish between different stimuli.

SIGNIFICANCE

These results indicate that direct cortical stimulation is a feasible option for sensory feedback with brain-computer interface devices.