Transcranial Alternating Current Stimulation to Modulate Alpha Activity: A Systematic Review

Individual alpha frequency tACS reduces static functional connectivity across the default mode network

Introduction

Research on the influence of transcranial alternating current stimulation over alpha functional connectivity (FC) is scarce, even when it poses as a potential treatment for various diseases. This study aimed to investigate the effects of individual alpha frequency tACS (IAF-tACS) on FC within the default mode network (DMN) in healthy individuals, particularly following the triple network model.

Materials and methods

27 healthy participants were recruited, who underwent a 20-min IAF-tACS session over parieto-occipital areas and three magnetoencephalography (MEG) recordings: two pre-stimulation and one post-stimulation. Participants were randomly assigned to either the stimulation or sham group. Both dynamic FC (dFC) and static FC (sFC) were evaluated through the leakage corrected amplitude envelope correlation (AEC-c). Statistical analyses compared both Pre-Post FC ratio between groups through ratio t-tests and intragroup FC changes through repeated measures t-tests, with FDR correction applied to account for multiple comparisons. An additional analysis simulated the influence of the cortical folding on the effect of tACS over FC.

Results

IAF-tACS significantly decreased sFC in intra- and inter-DMN links in the stimulation group compared to the sham group, with a special influence over antero-posterior links between hubs of the DMN. Negative correlations were found between AEC-c sFC changes and power alterations in posterior DMN areas, suggesting a complex interaction between cortical folding and electric field direction. On the other hand, dFC increased in both sham and stimulation groups, and no between-group differences were found.

Conclusion

Against our initial hypothesis, IAF-tACS reduced sFC in the DMN, possibly due to phase disparities introduced by cortical gyrification. These findings suggest that tACS might modulate FC in a more complex manner than previously thought, highlighting the need for further research into the personalized application of neuromodulation techniques, as well as its potential therapeutic implications for conditions like Alzheimer's disease.

Repeated application of bifocal transcranial alternating current stimulation improves network connectivity but not response inhibition: a double-blind sham control study

Mounting evidence suggests that transcranial alternating current stimulation can enhance response inhibition, a cognitive process crucial for sustained effort and decision-making. However, most studies have focused on within-session effects, with limited investigation into the effects of repeated applications, which are crucial for clinical applications. We examined the effects of repeated bifocal transcranial alternating current stimulation targeting the right inferior frontal gyrus and pre-supplementary motor area on response inhibition, functional connectivity, and simulated driving performance. Thirty young adults (18-35 yr) received either a sham or transcranial alternating current stimulation (20 Hz, 20 min) across 5 sessions over 2 wk. Resting-state electroencephalography assessed functional connectivity between the pre-supplementary motor area and right inferior frontal gyrus at baseline, the final transcranial alternating current stimulation session, and the 7-d follow-up. Response inhibition was measured using a stop-signal task, and driving performance was assessed before and after the intervention. The results showed significant improvements in functional connectivity in the transcranial alternating current stimulation group between sessions, though response inhibition and driving braking performance remained unchanged. However, while not the targeted behavior, general driving performance potentially improved following bifocal transcranial alternating current stimulation, with participants maintaining stable driving behavior alongside increased spare attentional capacity. These findings suggest that repeated bifocal transcranial alternating current stimulation may enhance cortical connectivity and related cognitive-motor processes, supporting its potential for clinical applications.

Efficacy and Safety of Bilateral Deep Brain Stimulation (DBS) for Severe Alzheimer's Disease: A Comparative Analysis of Fornix Versus Basal Ganglia of Meynert

BACKGROUND

Deep brain stimulation (DBS) is a novel therapy for severe Alzheimer's disease (AD). However, there is an ongoing debate regarding the optimal target for DBS, particularly the fornix and the basal ganglia of Meynert (NBM).

OBJECTIVE

This study aimed to investigate the safety and efficacy of DBS for severe AD and to compare the fornix and the NBM as potential targets.

METHODS

We conducted a prospective, nonrandomized clinical study involving 20 patients with severe AD (MMSE score 0 to 10, CDR level 3) from January 2015 to August 2022, comprising 12 males and eight females, with a mean age of 59.05 ± 6.45 years. All patients underwent DBS treatment, among which 14 received bilateral fornix implantation, while six received bilateral implantation in the NBM. Electrical stimulation commenced 1 month postoperatively. We assessed the patients before surgery, followed by evaluations at 1 month, 3 months, 6 months, and 12 months poststimulation. Primary outcome measures focused on changes in cognitive function, assessed using the MMSE, MoCA, ADAS-Cog, and CDR scales. Secondary measures encompassed quality of life, caregiver burden, neuropsychiatric symptoms, and sleep disturbances, evaluated through the BI, FAQ, FIM, ZBI, NPI, HAMA, HAMD, and PSQI scales.

RESULTS

All patients tolerated DBS well, with no serious adverse effects reported. Early on, DBS significantly improved cognitive function and quality of life. Long-term benefits include the improvement of neuropsychiatric symptoms and sleep disorders and the alleviation of caregiver burden. Comparison between DBS targeting the NBM and fornix revealed no significant differences in overall scale scores. However, upon deeper analysis, NBM-DBS exhibited a more pronounced improvement in neuropsychiatric symptoms, particularly in NPI scores.

CONCLUSION

DBS is a potential therapeutic approach for severe AD, capable of improving patients' cognitive function, quality of life, and neuropsychiatric symptoms. Notably, NBM-DBS showed distinct advantages in ameliorating neuropsychiatric symptoms, providing valuable insights for clinically selecting the optimal DBS target.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03115814.

Application and research progress of different frequency tACS in stroke rehabilitation: A systematic review

After a stroke, abnormal changes in neural oscillations that are related to the severity and prognosis of the disease can occur. Resetting these abnormal neural oscillations is a potential approach for stroke rehabilitation. Transcranial alternating current stimulation (tACS) can modulate intrinsic neural oscillations noninvasively and has attracted attention as a possible technique to improve multiple post-stroke symptoms, including deficits in speech, vision, and motor ability and overall neurological recovery. The clinical effect of tACS varies according to the selected frequency. Therefore, choosing an appropriate frequency to optimize outcomes for specific dysfunctions is essential. This review focuses on the current research status and possibilities of tACS with different frequencies in stroke rehabilitation. We also discuss the possible mechanisms of tACS in stroke to provide a theoretical foundation for the method and highlight the controversial aspects that need further exploration. Although tACS has great potential, few clinical studies have applied it in the treatment of stroke, and no consensus has been reached. We analyze limitations in experimental designs and identify potential tACS approaches worthy of exploration in the future.

Alpha rhythm transcranial electrical stimulation to inferior parietal cortex increases alpha power and phase synchrony while attending to mind-body self-states

Self-referential processing (SRP) refers to the human brain's response to semantic and somatic self-related information. Recent developments in modulating semantic and somatic SRP using non-invasive brain stimulation supported the efficacy of transcranial direct current stimulation in modulating alpha electroencephalography (alpha-EEG) during SRP. Meanwhile, although alpha transcranial alternating current stimulation (alpha-tACS) shows greater efficacy in modulating alpha-EEG, the efficacy of alpha-tACS for modulating alpha-EEG during SRP has not been evaluated. The current study investigates the effects of alpha-tACS compared to sham stimulation over the medial prefrontal cortex and the bilateral inferior parietal lobule on alpha-EEG during both semantic and somatic SRP in two separate experiments. Semantic SRP was provoked by introspection on life roles (e.g., "friend"), while somatic SRP was provoked by interoception upon sensations occurring in the exterior body (e.g., "shoulders") during the experimental task, and alpha-EEG responses during SRP were compared to those occurring during resting state and an external attention control condition. Results indicated that while alpha-tACS to the medial prefrontal cortex did not produce significant source-level alpha-EEG changes, alpha-tACS to inferior parietal cortex increased alpha-EEG source power and phase synchrony when participants received real stimulation during the first experimental session. An exploratory analysis also indicated that real stimulation reduced alpha-EEG power during semantic but not somatic SRP during the first session but not the second session. Our results demonstrate that while alpha-tACS can modulate alpha-EEG during SRP, the effects may be dependent on the ordering of real vs. sham stimulation sessions and stimulation sites.

Theta transcranial alternating current stimulation over the prefrontal cortex enhances theta power and working memory performance

Introduction

Transcranial alternating current stimulation (tACS) is a promising tool for modulating brain oscillations. This study investigated whether 5 Hz tACS could modulate neural oscillations in the prefrontal cortex and how this modulation impacts performance in working memory (WM) tasks.

Method

In two sessions, 28 healthy participants received 5 Hz tACS or sham stimulation over the left dorsolateral prefrontal cortex (DLPFC) while performing tasks with high and low WM loads. Resting-state EEG was recorded before and after stimulations for 5 minutes. EEG power was measured at electrodes surrounding the stimulation site.

Results

The results showed that tACS significantly improved reaction time (RT) compared to sham stimulation. This effect was task-specific, as tACS improved RT for hit responses only in high WM load trials, with no impact on low-load trials. Moreover, tACS significantly increased EEG power at 5 Hz and in the theta band compared to pre-stimulation levels.

Discussion

These findings demonstrate that tACS applied over left DLPFC modulates post-stimulation brain oscillations at the stimulation sites - known as tACS after-effects. Furthermore, the results suggest that 5 Hz tACS enhances response speed by elevating task-related activity in the prefrontal cortex to an optimal level for task performance.

Conclusion

In summary, the findings highlight the potential of tACS as a technique for modulating specific brain oscillations, with implications for research and therapeutic interventions.

Noninvasive Therapies: A Forthcoming Approach to Parkinson's Treatment

In this review, we have discussed the invasive and non-invasive treatment options for Parkinson's Disease (PD) following their safety, specificity, and reliability. Initially, this study has highlighted the invasive treatment options and the side effects they possess. A deep understanding of L-Dopa treatment, as oral or infusion, and the use of dopamine agonists has indicated that there is a need to acquire an alternative treatment for PD. The combined therapy with L-Dopa has been proven to affect PD, but with some limitations, such as mild to chronic side effects, with particular requirements of age and health of the patient and a large amount of expenditure. In the discussion of noninvasive methods to treat PD, we have found that this approach is comparatively slow and requires repetitive sessions, but is safe, effective, and reliable at any stage of PD. Electroconvulsive therapy has revealed its effectiveness in various neurological diseases, including PD. Transcranial current stimulation (direct or alternative) has already been shown to have an alleviative response to PD symptoms. Transcranial magnetic stimulations and other strategies of using the magnetic field for potential treatment options for PD need to be explored further imminently.

Alpha and beta/low-gamma frequency bands may have distinct neural origin and function during post-stroke walking

Plantarflexors provide propulsion during walking and receive input from both corticospinal and corticoreticulospinal tracts, which exhibit some frequency-specificity that allows potential differentiation of each tract's descending drive. Given that stroke may differentially affect each tract and impair the function of plantarflexors during walking; here, we examined this frequency-specificity and its relation to walking-specific measures during post-stroke walking. Fourteen individuals with chronic stroke walked on an instrumented treadmill at self-selected and fast walking speed (SSWS and FWS, respectively) while surface electromyography (sEMG) from soleus (SOL), lateral gastrocnemius (LG), and medial gastrocnemius (MG) and ground reaction forces (GRF) were collected. We calculated the intermuscular coherences (IMC; alpha, beta, and low-gamma bands between SOL-LG, SOL-MG, LG-MG) and propulsive impulse using sEMG and GRF, respectively. We examined the interlimb and intralimb IMC comparisons and their relationships with propulsive impulse and walking speed. Interlimb IMC comparisons revealed that beta LG-MG (SSWS) and low-gamma SOL-LG (FWS) IMCs were degraded on the paretic side. Intralimb IMC comparisons revealed that only alpha IMCs (both speeds) exhibited a statistically significant difference to random coherence. Further, alpha LG-MG IMC was positively correlated with propulsive impulse in the paretic limb (SSWS). Alpha and beta/low-gamma bands may have a differential functional role, which may be related to the frequency-specificity of the underlying descending drives. The persistence of alpha band in plantarflexors and its strong positive relationship with propulsive impulse suggests relative alteration of corticoreticulospinal tract after stroke. These findings imply the presence of frequency-specific descending drives to walking-specific muscles in chronic stroke.

Modulation of brain activity in brain-injured patients with a disorder of consciousness in intensive care with repeated 10-Hz transcranial alternating current stimulation (tACS): a randomised controlled trial protocol

INTRODUCTION

Therapeutic interventions for disorders of consciousness lack consistency; evidence supports non-invasive brain stimulation, but few studies assess neuromodulation in acute-to-subacute brain-injured patients. This study aims to validate the feasibility and assess the effect of a multi-session transcranial alternating current stimulation (tACS) intervention in subacute brain-injured patients on recovery of consciousness, related brain oscillations and brain network dynamics.

METHODS AND ANALYSES

The study is comprised of two phases: a validation phase (n=12) and a randomised controlled trial (n=138). Both phases will be conducted in medically stable brain-injured adult patients (traumatic brain injury and hypoxic-ischaemic encephalopathy), with a Glasgow Coma Scale score ≤12 after continuous sedation withdrawal. Recruitment will occur at the intensive care unit of a Level 1 Trauma Centre in Montreal, Quebec, Canada. The intervention includes a 20 min 10 Hz tACS at 1 mA intensity or a sham session over parieto-occipital cortical sites, repeated over five consecutive days. The current's frequency targets alpha brain oscillations (8-13 Hz), known to be associated with consciousness. Resting-state electroencephalogram (EEG) will be recorded four times daily for five consecutive days: pre and post-intervention, at 60 and 120 min post-tACS. Two additional recordings will be included: 24 hours and 1-week post-protocol. Multimodal measures (blood samples, pupillometry, behavioural consciousness assessments (Coma Recovery Scale-revised), actigraphy measures) will be acquired from baseline up to 1 week after the stimulation. EEG signal analysis will focus on the alpha bandwidth (8-13 Hz) using spectral and functional network analyses. Phone assessments at 3, 6 and 12 months post-tACS, will measure long-term functional recovery, quality of life and caregivers' burden.

ETHICS AND DISSEMINATION

Ethical approval for this study has been granted by the Research Ethics Board of the CIUSSS du Nord-de-l'Île-de-Montréal (Project ID 2021-2279). The findings of this two-phase study will be submitted for publication in a peer-reviewed academic journal and submitted for presentation at conferences. The trial's results will be published on a public trial registry database (ClinicalTrials.gov).

TRIAL REGISTRATION NUMBER

NCT05833568.

Excitation-Inhibition Imbalance in Migraine: From Neurotransmitters to Brain Oscillations

Migraine is among the most common and debilitating neurological disorders typically affecting people of working age. It is characterised by a unilateral, pulsating headache often associated with severe pain. Despite the intensive research, there is still little understanding of the pathophysiology of migraine. At the electrophysiological level, altered oscillatory parameters have been reported within the alpha and gamma bands. At the molecular level, altered glutamate and GABA concentrations have been reported. However, there has been little cross-talk between these lines of research. Thus, the relationship between oscillatory activity and neurotransmitter concentrations remains to be empirically traced. Importantly, how these indices link back to altered sensory processing has to be clearly established as yet. Accordingly, pharmacologic treatments have been mostly symptom-based, and yet sometimes proving ineffective in resolving pain or related issues. This review provides an integrative theoretical framework of excitation-inhibition imbalance for the understanding of current evidence and to address outstanding questions concerning the pathophysiology of migraine. We propose the use of computational modelling for the rigorous formulation of testable hypotheses on mechanisms of homeostatic imbalance and for the development of mechanism-based pharmacological treatments and neurostimulation interventions.