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Oberman LM, Francis SM, Lisanby SH. The use of noninvasive brain stimulation techniques in autism spectrum disorder. Autism Res 2024; 17:17-26. [PMID: 37873560 PMCID: PMC10841888 DOI: 10.1002/aur.3041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/15/2023] [Indexed: 10/25/2023]
Abstract
Noninvasive brain stimulation (NIBS) techniques, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have recently emerged as alternative, nonpharmacological interventions for a variety of psychiatric, neurological, and neurodevelopmental conditions. NIBS is beginning to be applied in both research and clinical settings for the treatment of core and associated symptoms of autism spectrum disorder (ASD) including social communication deficits, restricted and repetitive behaviors, irritability, hyperactivity, depression and impairments in executive functioning and sensorimotor integration. Though there is much promise for these targeted device-based interventions, in other disorders (including adult major depressive disorder (MDD) and obsessive compulsive disorder (OCD) where rTMS is FDA cleared), data on the safety and efficacy of these interventions in individuals with ASD is limited especially in younger children when neurodevelopmental interventions typically begin. Most studies are open-label, small scale, and/or focused on a restricted subgroup of individuals with ASD. There is a need for larger, randomized controlled trials that incorporate neuroimaging in order to develop predictive biomarkers of treatment response and optimize treatment parameters. We contend that until such studies are conducted, we do not have adequate estimates of the safety and efficacy of NIBS interventions in children across the spectrum. Thus, broad off-label use of these techniques in this population is not supported by currently available evidence. Here we discuss the existing data on the use of NIBS to treat symptoms related to ASD and discuss future directions for the field.
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Affiliation(s)
- Lindsay M Oberman
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Sunday M Francis
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Sarah H Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
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Kumpf U, Ezim H, Stadler M, Burkhardt G, Palm U, Dechantsreiter E, Padberg F. Transcranial direct current stimulation as treatment for major depression in a home treatment setting (HomeDC trial): study protocol and methodology of a double-blind, placebo-controlled pilot study. Pilot Feasibility Stud 2023; 9:197. [PMID: 38102647 PMCID: PMC10722795 DOI: 10.1186/s40814-023-01423-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/21/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Transcranial direct current stimulation (tDCS) of prefrontal cortex regions has been reported to exert therapeutic effects in patients with major depressive disorder (MDD). Due to its beneficial safety profile, its easy mode of application, and its cost-effectiveness, tDCS has recently been proposed for treatment at home. This would offer new chances for regionally widespread and long-term application. However, tDCS at home must meet the new methodological challenges of handling and adherence. At the same time, data from randomized controlled trials (RCT) investigating this mode of application are still lacking. In this pilot RCT, we therefore investigate the feasibility, safety, and effectiveness of a new antidepressant tDCS application set-up. METHODS AND ANALYSIS The HomeDC trial will be conducted as a double-blind, placebo-controlled, parallel-group design trial. Thirty-two study participants with MDD will be randomly assigned to active or sham tDCS groups. Participants will self-administer prefrontal tDCS for 6 weeks. Active tDCS will be conducted with anode over F3, cathode over F4, for 5 sessions/week, with a duration of 30 min/day, and 2 mA stimulation intensity. Sham tDCS, conversely, follows an identical protocol in regard to electrode montage and timing, but with no electric stimulation between the ramp-in and ramp-out periods. Both conditions will be administered either as a monotherapy or an adjunctive treatment to a stable dose of antidepressant medication. Adjunctive magnetic resonance imaging (MRI) and electric field (E-field) modelling will be conducted at baseline. Primary outcome is feasibility based on successfully completed stimulations and drop-out rates. The intervention is considered feasible when 20 out of 30 sessions have been fully conducted by at least 75% of the participants. Effectiveness and safety will be assessed as secondary outcomes. DISCUSSION In the HomeDC trial, the technical requirements for a placebo-controlled tDCS study in a home-based treatment setting have been established. The trial addresses the crucial points of the home-based tDCS treatment approach: uniform electrode positioning, frequent monitoring of stimulation parameters, adherence, and ensuring an appropriate home treatment environment. This study will further identify constraints and drawbacks of this novel mode of treatment. TRIAL REGISTRATION www. CLINICALTRIALS gov . TRIAL REGISTRATION NUMBER NCT05172505. Registration date: 12/13/2021.
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Affiliation(s)
- Ulrike Kumpf
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Nussbaumstr. 7, 80336, Munich, Germany.
| | - Harry Ezim
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Matthias Stadler
- Faculty of Psychology and Educational Sciences, Ludwig Maximilian University Munich, Munich, Germany
| | - Gerrit Burkhardt
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Ulrich Palm
- Medicalpark Chiemseeblick, Bernau-Felden, Germany
| | - Esther Dechantsreiter
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Nussbaumstr. 7, 80336, Munich, Germany
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Imperio CM, Chua EF. Differential effects of remotely supervised transcranial direct current stimulation on recognition memory depending on task order. Front Hum Neurosci 2023; 17:1239126. [PMID: 37635805 PMCID: PMC10450219 DOI: 10.3389/fnhum.2023.1239126] [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: 06/12/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Background Prior work has shown positive effects of High Definition transcranial direct current stimulation (HD-tDCS) over the dorsolateral prefrontal cortex (DLPFC) on semantic memory performance and metamemory monitoring accuracy. However, HD-tDCS requires setup by a trained researcher, which is not always feasible. Few studies have used remotely supervised (rs) tDCS in healthy populations, and remote supervision has strong practical benefits. Objective/hypothesis The goal of the current study was to test if previously shown effects of HD-tDCS over the left DLPFC on semantic memory performance and metamemory monitoring accuracy extended to conventional rs-tDCS, which is less focal than HD-tDCS, and to episodic memory and metamemory tasks. Materials and methods A total of 36 healthy participants completed 6 weeks of rs-tDCS sessions, with either active left or right anodal DLPFC stimulation, or sham. Participants completed semantic and episodic memory and metamemory tasks, which each lasted for three consecutive sessions, and session order was counterbalanced across participants. Results Overall, there were no main effects of rs-tDCS on metamemory monitoring accuracy or memory performance for either the semantic or the episodic tasks. However, there were effects of rs-tDCS that depended on the order of completing the episodic and semantic task sessions. When participants completed the semantic task sessions after the episodic task sessions, semantic recognition was greater in the left anodal DLPFC condition. In a parallel effect, when participants completed the episodic task sessions after the semantic task sessions, episodic recognition was greater in the right anodal DLPFC condition. Conclusion Prior experience with tDCS is a factor for effects of rs-tDCS on cognition. Additionally, the current experiment provides evidence for the feasibility of fully remotely supervised tDCS in healthy participants.
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Affiliation(s)
- Casey M. Imperio
- Department of Psychology, Brooklyn College, Brooklyn, NY, United States
- Department of Psychology, The Graduate Center of the City University of New York, New York, NY, United States
| | - Elizabeth F. Chua
- Department of Psychology, Brooklyn College, Brooklyn, NY, United States
- Department of Psychology, The Graduate Center of the City University of New York, New York, NY, United States
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Cappon D, den Boer T, Yu W, LaGanke N, Fox R, Brozgol M, Hausdorff JM, Manor B, Pascual-Leone A. An Educational Program for Remote Training and Supervision of Home-Based Transcranial Electrical Stimulation: Feasibility and Preliminary Effectiveness. Neuromodulation 2023:S1094-7159(23)00671-2. [PMID: 37552152 PMCID: PMC10850429 DOI: 10.1016/j.neurom.2023.04.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/14/2023] [Accepted: 04/03/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES There has been recent interest in the administration of transcranial electrical stimulation (tES) by a caregiver, family member, or patient themselves while in their own homes (HB-tES). The need to properly train individuals in the administration of HB-tES is essential, and the lack of a uniform training approach across studies has come to light. The primary aim of this paper is to present the HB-tES training and supervision program, a tele-supervised, instructional, and evaluation program to teach laypersons how to administer HB-tES to a participant and to provide a standardized framework for remote monitoring of participants by teaching staff. The secondary aim is to present early pilot data on the feasibility and effectiveness of the training portion of the program based on its implementation in 379 sessions between two pilot clinical trials. MATERIALS AND METHODS The program includes instructional materials, standardized tele-supervised hands-on practice sessions, and a system for remote supervision of participants by teaching staff. Nine laypersons completed the training program. Data on the feasibility and effectiveness of the program were collected. RESULTS No adverse events were reported during the training or any of the HB-tES sessions after the training. All laypersons successfully completed the training. The nine laypersons reported being satisfied with the training program and confident in their tES administration capabilities. This was consistent with laypersons requiring technical assistance from teaching staff very infrequently during the 379 completed sessions. The average adherence rate between all administrators was >98%, with seven of nine administrators having 100% adherence to the scheduled sessions. CONCLUSIONS These findings indicate that the HB-tES program is effective and is associated with participant satisfaction. SIGNIFICANCE We hope that the remote nature of this training program will facilitate increased accessibility to HB-tES research for participants of different demographics and locations. This program, designed for easy adaptation to different HB-tES research applications and devices, also is accessible online. The adoption of this program is expected to facilitate uniformity of study methods among future HB-tES studies and thereby accelerate the pace of tES intervention discovery.
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Affiliation(s)
- Davide Cappon
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA; Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA.
| | - Tim den Boer
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA
| | - Nicole LaGanke
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA
| | - Rachel Fox
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA; Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, USA
| | - Marina Brozgol
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, and Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA; Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
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Examining the synergistic effects of a cognitive control video game and a home-based, self-administered non-invasive brain stimulation on alleviating depression: the DiSCoVeR trial protocol. Eur Arch Psychiatry Clin Neurosci 2023; 273:85-98. [PMID: 36271928 PMCID: PMC9589526 DOI: 10.1007/s00406-022-01464-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
Enhanced behavioral interventions are gaining increasing interest as innovative treatment strategies for major depressive disorder (MDD). In this study protocol, we propose to examine the synergistic effects of a self-administered home-treatment, encompassing transcranial direct current stimulation (tDCS) along with a video game based training of attentional control. The study is designed as a two-arm, double-blind, randomized and placebo-controlled multi-center trial (ClinicalTrials.gov: NCT04953208). At three study sites (Israel, Latvia, and Germany), 114 patients with a primary diagnosis of MDD undergo 6 weeks of intervention (30 × 30 min sessions). Patients assigned to the intervention group receive active tDCS (anode F3 and cathode F4; 2 mA intensity) and an action-like video game, while those assigned to the control group receive sham tDCS along with a control video game. An electrode-positioning algorithm is used to standardize tDCS electrode positioning. Participants perform their designated treatment at the clinical center (sessions 1-5) and continue treatment at home under remote supervision (sessions 6-30). The endpoints are feasibility (primary) and safety, treatment efficacy (secondary, i.e., change of Montgomery-Åsberg Depression Rating Scale (MADRS) scores at week six from baseline, clinical response and remission, measures of social, occupational, and psychological functioning, quality of life, and cognitive control (tertiary). Demonstrating the feasibility, safety, and efficacy of this novel combined intervention could expand the range of available treatments for MDD to neuromodulation enhanced interventions providing cost-effective, easily accessible, and low-risk treatment options.ClinicalTrials.gov: NCT04953208.
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Pilloni G, Charvet LE, Bikson M, Palekar N, Kim MJ. Potential of Transcranial Direct Current Stimulation in Alzheimer's Disease: Optimizing Trials Toward Clinical Use. J Clin Neurol 2022; 18:391-400. [PMID: 35796264 PMCID: PMC9262447 DOI: 10.3988/jcn.2022.18.4.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a safe and well-tolerated noninvasive method for stimulating the brain that is rapidly developing into a treatment method for various neurological and psychiatric conditions. In particular, there is growing evidence of a therapeutic role for tDCS in ameliorating or delaying the cognitive decline in Alzheimer's disease (AD). We provide a brief overview of the current development and application status of tDCS as a nonpharmacological therapeutic method for AD and mild cognitive impairment (MCI), summarize the levels of evidence, and identify the improvements needed for clinical applications. We also suggest future directions for large-scale controlled clinical trials of tDCS in AD and MCI, and emphasize the necessity of identifying the mechanistic targets to facilitate clinical applications.
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Affiliation(s)
- Giuseppina Pilloni
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Leigh E Charvet
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, City University of New York, NY, USA
| | - Nikhil Palekar
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Min-Jeong Kim
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA.
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A Novel Highly Durable Carbon/Silver/Silver Chloride Composite Electrode for High-Definition Transcranial Direct Current Stimulation. NANOMATERIALS 2021; 11:nano11081962. [PMID: 34443793 PMCID: PMC8400871 DOI: 10.3390/nano11081962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
High-definition transcranial direct current stimulation (HD-tDCS) is a promising non-invasive neuromodulation technique, which has been widely used in the clinical intervention and treatment of neurological or psychiatric disorders. Sintered Ag/AgCl electrode has become a preferred candidate for HD-tDCS, but its service life is very short, especially for long-term anodal stimulation. To address this issue, a novel highly durable conductive carbon/silver/silver chloride composite (C/Ag/AgCl) electrode was fabricated by a facile cold rolling method. The important parameters were systematically optimized, including the conductive enhancer, the particle size of Ag powder, the C:Ag:PTFE ratio, the saline concentration, and the active substance loading. The CNT/Ag/AgCl-721 electrode demonstrated excellent specific capacity and cycling performance. Both constant current anodal polarization and simulated tDCS measurement demonstrated that the service life of the CNT/Ag/AgCl-721 electrodes was 15-16 times of that of sintered Ag/AgCl electrodes. The much longer service life can be attributed to the formation of the three-dimensional interpenetrating conductive network with CNT doping, which can maintain a good conductivity and cycling performance even if excessive non-conductive AgCl is accumulated on the surface during long-term anodal stimulation. Considering their low cost, long service life, and good skin tolerance, the proposed CNT/Ag/AgCl electrodes have shown promising application prospects in HD-tDCS, especially for daily life scenarios.
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Eilam-Stock T, George A, Charvet LE. Cognitive Telerehabilitation with Transcranial Direct Current Stimulation Improves Cognitive and Emotional Functioning Following a Traumatic Brain Injury: A Case Study. Arch Clin Neuropsychol 2021; 36:442-453. [PMID: 33885138 DOI: 10.1093/arclin/acaa059] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/08/2020] [Accepted: 07/12/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Cognitive deficits following a traumatic brain injury (TBI) are a leading cause of disability in young adults and there is a critical need for novel approaches to improve cognitive outcomes in TBI survivors. Transcranial direct current stimulation (tDCS) paired with cognitive remediation has emerged as a viable, cost-effective, noninvasive approach for treating cognitive impairments in a wide variety of neurological conditions. Here, we report the first case study utilizing remotely supervised tDCS (RS-tDCS) protocol paired with cognitive remediation in a 29-year-old man with persisting cognitive and emotional sequelae following TBI. METHOD Neuropsychological measures were administered before and after the patient completed 20 daily sessions of RS-tDCS (2.0 mA × 20 minutes, left anodal dorsolateral prefrontal cortex montage). During the daily stimulation period, he completed adaptive cognitive training. All treatment procedures were delivered at home and monitored in real time via videoconference with a study technician. RESULTS Following 20 RS-tDCS and cognitive training sessions, he had significant improvements (>1 SD) on tests of attention and working memory, semantic fluency, and information processing speed. Mood was also improved. CONCLUSIONS This is the first demonstration of at-home telerehabilitation with RS-tDCS and cognitive training to improve cognitive outcomes following TBI.
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Affiliation(s)
- Tehila Eilam-Stock
- Department of Neurology, NYU Grossman School of Medicine, New York 10017, USA
| | - Allan George
- Department of Neurology, NYU Grossman School of Medicine, New York 10017, USA
| | - Leigh E Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York 10017, USA
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Baptista AF, Baltar A, Okano AH, Moreira A, Campos ACP, Fernandes AM, Brunoni AR, Badran BW, Tanaka C, de Andrade DC, da Silva Machado DG, Morya E, Trujillo E, Swami JK, Camprodon JA, Monte-Silva K, Sá KN, Nunes I, Goulardins JB, Bikson M, Sudbrack-Oliveira P, de Carvalho P, Duarte-Moreira RJ, Pagano RL, Shinjo SK, Zana Y. Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19. Front Neurol 2020; 11:573718. [PMID: 33324324 PMCID: PMC7724108 DOI: 10.3389/fneur.2020.573718] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19. Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders. Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders. Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway. Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.
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Affiliation(s)
- Abrahão Fontes Baptista
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Brazilian Institute of Neuroscience and Neurotechnology Centros de Pesquisa, Investigação e Difusão - Fundação de Amparo à Pesquisa do Estado de São Paulo (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, Brazil
- Laboratory of Medical Investigations 54 (LIM-54), São Paulo University, São Paulo, Brazil
| | - Adriana Baltar
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Specialized Neuromodulation Center—Neuromod, Recife, Brazil
| | - Alexandre Hideki Okano
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Brazilian Institute of Neuroscience and Neurotechnology Centros de Pesquisa, Investigação e Difusão - Fundação de Amparo à Pesquisa do Estado de São Paulo (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, Brazil
- Graduate Program in Physical Education, State University of Londrina, Londrina, Brazil
| | - Alexandre Moreira
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | - Ana Mércia Fernandes
- Centro de Dor, LIM-62, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - André Russowsky Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria, São Paulo, Brazil
- Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bashar W. Badran
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Clarice Tanaka
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Laboratory of Medical Investigations 54 (LIM-54), São Paulo University, São Paulo, Brazil
- Instituto Central, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Centro de Dor, LIM-62, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Edgard Morya
- Edmond and Lily Safra International Neuroscience Institute, Santos Dumont Institute, Macaiba, Brazil
| | - Eduardo Trujillo
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
| | - Jaiti K. Swami
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, United States
| | - Joan A. Camprodon
- Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Katia Monte-Silva
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Brazil
| | - Katia Nunes Sá
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Isadora Nunes
- Department of Physiotherapy, Pontifícia Universidade Católica de Minas Gerais, Betim, Brazil
| | - Juliana Barbosa Goulardins
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Laboratory of Medical Investigations 54 (LIM-54), São Paulo University, São Paulo, Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
- Universidade Cruzeiro do Sul (UNICSUL), São Paulo, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, United States
| | | | - Priscila de Carvalho
- Instituto Central, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafael Jardim Duarte-Moreira
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
| | | | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Yossi Zana
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
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Bikson M, Hanlon CA, Woods AJ, Gillick BT, Charvet L, Lamm C, Madeo G, Holczer A, Almeida J, Antal A, Ay MR, Baeken C, Blumberger DM, Campanella S, Camprodon JA, Christiansen L, Loo C, Crinion JT, Fitzgerald P, Gallimberti L, Ghobadi-Azbari P, Ghodratitoostani I, Grabner RH, Hartwigsen G, Hirata A, Kirton A, Knotkova H, Krupitsky E, Marangolo P, Nakamura-Palacios EM, Potok W, Praharaj SK, Ruff CC, Schlaug G, Siebner HR, Stagg CJ, Thielscher A, Wenderoth N, Yuan TF, Zhang X, Ekhtiari H. Guidelines for TMS/tES clinical services and research through the COVID-19 pandemic. Brain Stimul 2020; 13:1124-1149. [PMID: 32413554 PMCID: PMC7217075 DOI: 10.1016/j.brs.2020.05.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has broadly disrupted biomedical treatment and research including non-invasive brain stimulation (NIBS). Moreover, the rapid onset of societal disruption and evolving regulatory restrictions may not have allowed for systematic planning of how clinical and research work may continue throughout the pandemic or be restarted as restrictions are abated. The urgency to provide and develop NIBS as an intervention for diverse neurological and mental health indications, and as a catalyst of fundamental brain research, is not dampened by the parallel efforts to address the most life-threatening aspects of COVID-19; rather in many cases the need for NIBS is heightened including the potential to mitigate mental health consequences related to COVID-19. OBJECTIVE To facilitate the re-establishment of access to NIBS clinical services and research operations during the current COVID-19 pandemic and possible future outbreaks, we develop and discuss a framework for balancing the importance of NIBS operations with safety considerations, while addressing the needs of all stakeholders. We focus on Transcranial Magnetic Stimulation (TMS) and low intensity transcranial Electrical Stimulation (tES) - including transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS). METHODS The present consensus paper provides guidelines and good practices for managing and reopening NIBS clinics and laboratories through the immediate and ongoing stages of COVID-19. The document reflects the analysis of experts with domain-relevant expertise spanning NIBS technology, clinical services, and basic and clinical research - with an international perspective. We outline regulatory aspects, human resources, NIBS optimization, as well as accommodations for specific demographics. RESULTS A model based on three phases (early COVID-19 impact, current practices, and future preparation) with an 11-step checklist (spanning removing or streamlining in-person protocols, incorporating telemedicine, and addressing COVID-19-associated adverse events) is proposed. Recommendations on implementing social distancing and sterilization of NIBS related equipment, specific considerations of COVID-19 positive populations including mental health comorbidities, as well as considerations regarding regulatory and human resource in the era of COVID-19 are outlined. We discuss COVID-19 considerations specifically for clinical (sub-)populations including pediatric, stroke, addiction, and the elderly. Numerous case-examples across the world are described. CONCLUSION There is an evident, and in cases urgent, need to maintain NIBS operations through the COVID-19 pandemic, including anticipating future pandemic waves and addressing effects of COVID-19 on brain and mind. The proposed robust and structured strategy aims to address the current and anticipated future challenges while maintaining scientific rigor and managing risk.
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Affiliation(s)
- Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, USA
| | - Colleen A Hanlon
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Bernadette T Gillick
- Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, MN, Minneapolis, USA
| | - Leigh Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Claus Lamm
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Adrienn Holczer
- Department of Neurology, Albert Szent-Györgyi Health Center, Faculty of Medicine, University of Szeged, Hungary
| | - Jorge Almeida
- Proaction Lab, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal; CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany; Institute of Medical Psychology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Mohammad Reza Ay
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | - Chris Baeken
- Faculty of Medicine and Health Sciences, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et D'Addiction, ULB Neuroscience Institute (UNI), Université Libre de Bruxelles (ULB), Place Vangehuchten, B-1020, Brussels, Belgium
| | - Joan A Camprodon
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lasse Christiansen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Colleen Loo
- School of Psychiatry & Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Jennifer T Crinion
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Paul Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare and Department of Psychiatry, Monash University, Camberwell, Victoria, Australia
| | | | - Peyman Ghobadi-Azbari
- Department of Biomedical Engineering, Shahed University, Tehran, Iran; Iranian National Center for Addiction Studies (INCAS), Tehran, Iran
| | - Iman Ghodratitoostani
- Neurocognitive Engineering Laboratory (NEL), Center for Mathematical Sciences Applied to Industry, Institute of Mathematical and Computer Sciences, University of Sao Paulo, Brazil
| | - Roland H Grabner
- Educational Neuroscience, Institute of Psychology, University of Graz, Austria
| | - Gesa Hartwigsen
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Akimasa Hirata
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University, V. M. Bekhterev National Research Medical Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Paola Marangolo
- Department of Humanities Studies, University Federico II, Naples, Italy; Aphasia Research Lab, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Weronika Potok
- Neural Control of Movement Lab, Department of Health Science and Technology, ETH Zurich, Switzerland
| | - Samir K Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Christian C Ruff
- Zurich Center for Neuroeconomics (ZNE), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Gottfried Schlaug
- Neuroimaging-Neuromodulation and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Baystate Medical Center, UMass Medical School, MA, USA
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences and Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte J Stagg
- Wellcome Centre for Integrative Neuroimaging and MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Nicole Wenderoth
- Neural Control of Movement Lab, Department of Health Science and Technology, ETH Zurich, Switzerland
| | - Ti-Fei Yuan
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaochu Zhang
- CAS Key Laboratory of Brain Function and Disease and School of Life Sciences, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, China
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Pilloni G, Choi C, Coghe G, Cocco E, Krupp LB, Pau M, Charvet LE. Gait and Functional Mobility in Multiple Sclerosis: Immediate Effects of Transcranial Direct Current Stimulation (tDCS) Paired With Aerobic Exercise. Front Neurol 2020; 11:310. [PMID: 32431658 PMCID: PMC7214839 DOI: 10.3389/fneur.2020.00310] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/31/2020] [Indexed: 12/22/2022] Open
Abstract
Walking impairments are a debilitating feature of multiple sclerosis (MS) because of the direct interference with daily activity. The management of motor symptoms in those with MS remains a therapeutic challenge. Transcranial direct current stimulation (tDCS) is a type of non-invasive brain stimulation that is emerging as a promising rehabilitative tool but requires further characterization to determine its optimal therapeutic use. In this randomized, sham-controlled proof-of-concept study, we tested the immediate effects of a single tDCS session on walking and functional mobility in those with MS. Seventeen participants with MS completed one 20-min session of aerobic exercise, randomly assigned to be paired with either active (2.5 mA, n = 9) or sham (n = 8) tDCS over the primary motor cortex (M1). The groups (active vs. sham) were matched according to gender (50% vs. 60% F), age (52.1 ± 12.85 vs. 54.2 ± 8.5 years), and level of neurological disability (median Expanded Disability Status Scale score 5.5 vs. 5). Gait speed on the 10-m walk test and the Timed Up and Go (TUG) time were measured by a wearable inertial sensor immediately before and following the 20-min session, with changes compared between conditions and time. There were no significant differences in gait speed or TUG time changes following the session in the full sample or between the active vs. sham groups. These findings suggest that a single session of anodal tDCS over M1 is not sufficient to affect walking and functional mobility in those with MS. Instead, behavioral motor response of tDCS is likely to be cumulative, and the effects of multiple tDCS sessions require further study. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03658668.
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Affiliation(s)
- Giuseppina Pilloni
- NYU Langone Health, Department of Neurology, New York, NY, United States.,Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Claire Choi
- SUNY Downstate, Department of Medicine, New York, NY, United States
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Lauren B Krupp
- NYU Langone Health, Department of Neurology, New York, NY, United States
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Leigh E Charvet
- NYU Langone Health, Department of Neurology, New York, NY, United States
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