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Alashram AR. Combined noninvasive brain stimulation virtual reality for upper limb rehabilitation poststroke: A systematic review of randomized controlled trials. Neurol Sci 2024; 45:2523-2537. [PMID: 38286919 DOI: 10.1007/s10072-024-07360-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
Upper limb impairments are common consequences of stroke. Noninvasive brain stimulation (NIBS) and virtual reality (VR) play crucial roles in improving upper limb function poststroke. This review aims to evaluate the effects of combined NIBS and VR interventions on upper limb function post-stroke and to provide recommendations for future studies in the rehabilitation field. PubMed, MEDLINE, PEDro, SCOPUS, REHABDATA, EMBASE, and Web of Science were searched from inception to November 2023. Randomized controlled trials (RCTs) encompassed patients with a confirmed stroke diagnosis, administrated combined NIBS and VR compared with passive (i.e., rest) or active (conventional therapy), and included at least one outcome assessing upper limb function (i.e., strength, spasticity, function) were selected. The quality of the included studies was assessed using the Cochrane Collaboration tool. Seven studies met the eligibility criteria. In total, 303 stroke survivors (Mean age: 61.74 years) were included in this review. According to the Cochrane Collaboration tool, five studies were classified as "high quality," while two were categorized as "moderate quality". There are mixed findings for the effects of combined NIBS and VR on upper limb function in stroke survivors. The evidence for the effects of combined transcranial direct current stimulation and VR on upper limb function post-stroke is promising. However, the evidence regarding the effects of combined repetitive transcranial magnetic stimulation and VR on upper limb function is limited. Further randomized controlled trials with long-term follow-up are strongly warranted.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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Pruitt T, Davenport EM, Proskovec AL, Maldjian JA, Liu H. Simultaneous MEG and EEG source imaging of electrophysiological activity in response to acute transcranial photobiomodulation. Front Neurosci 2024; 18:1368172. [PMID: 38817913 PMCID: PMC11137218 DOI: 10.3389/fnins.2024.1368172] [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: 01/10/2024] [Accepted: 04/22/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Transcranial photobiomodulation (tPBM) is a non-invasive neuromodulation technique that improves human cognition. The effects of tPBM of the right forehead on neurophysiological activity have been previously investigated using EEG in sensor space. However, the spatial resolution of these studies is limited. Magnetoencephalography (MEG) is known to facilitate a higher spatial resolution of brain source images. This study aimed to image post-tPBM effects in brain space based on both MEG and EEG measurements across the entire human brain. Methods MEG and EEG scans were concurrently acquired for 6 min before and after 8-min of tPBM delivered using a 1,064-nm laser on the right forehead of 25 healthy participants. Group-level changes in both the MEG and EEG power spectral density with respect to the baseline (pre-tPBM) were quantified and averaged within each frequency band in the sensor space. Constrained modeling was used to generate MEG and EEG source images of post-tPBM, followed by cluster-based permutation analysis for family wise error correction (p < 0.05). Results The 8-min tPBM enabled significant increases in alpha (8-12 Hz) and beta (13-30 Hz) powers across multiple cortical regions, as confirmed by MEG and EEG source images. Moreover, tPBM-enhanced oscillations in the beta band were located not only near the stimulation site but also in remote cerebral regions, including the frontal, parietal, and occipital regions, particularly on the ipsilateral side. Discussion MEG and EEG results shown in this study demonstrated that tPBM modulates neurophysiological activity locally and in distant cortical areas. The EEG topographies reported in this study were consistent with previous observations. This study is the first to present MEG and EEG evidence of the electrophysiological effects of tPBM in the brain space, supporting the potential utility of tPBM in treating neurological diseases through the modulation of brain oscillations.
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Affiliation(s)
- Tyrell Pruitt
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, United States
| | | | - Amy L. Proskovec
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Joseph A. Maldjian
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States
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Nascimento Guimarães A, Beggiato Porto A, Junior Guidotti F, Soca Bazo N, Ugrinowitsch H, Hugo Alves Okazaki V. Effect of Transcranial direct current stimulation of the Primary motor Cortex and cerebellum on motor control and learning of geometric drawing tasks with varied cognitive demands. Brain Res 2024; 1828:148786. [PMID: 38266889 DOI: 10.1016/j.brainres.2024.148786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Anderson Nascimento Guimarães
- State University of Londrina, Department of Physical Education, Rodovia Celso Garcia Cid - Pr 445, Km 380, Campus Universitário, Londrina, Brazil.
| | - Alessandra Beggiato Porto
- State University of Londrina, Department of Physical Education, Rodovia Celso Garcia Cid - Pr 445, Km 380, Campus Universitário, Londrina, Brazil
| | - Flavio Junior Guidotti
- State University of Londrina, Department of Physical Education, Rodovia Celso Garcia Cid - Pr 445, Km 380, Campus Universitário, Londrina, Brazil
| | - Norberto Soca Bazo
- State University of Londrina, Department of Physical Education, Rodovia Celso Garcia Cid - Pr 445, Km 380, Campus Universitário, Londrina, Brazil; Licungo University, Department of Physical Education and Sports, Rua de Comandante Gaivão Extensão da Beira, Moçambique
| | - Herbert Ugrinowitsch
- Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos, 6627, CEP 31270-901, Belo Horizonte MG, Brazil
| | - Victor Hugo Alves Okazaki
- State University of Londrina, Department of Physical Education, Rodovia Celso Garcia Cid - Pr 445, Km 380, Campus Universitário, Londrina, Brazil
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Zhang HY, Hou TT, Jin ZH, Zhang T, Wang YH, Cheng ZH, Liu YH, Fang JP, Yan HJ, Zhen Y, An X, Du J, Chen KK, Li ZZ, Li Q, Wen QP, Fang BY. Transcranial alternating current stimulation improves quality of life in Parkinson's disease: study protocol for a randomized, double-blind, controlled trial. Trials 2024; 25:200. [PMID: 38509589 PMCID: PMC10953283 DOI: 10.1186/s13063-024-08045-5] [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: 12/27/2023] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The neural cells in the brains of patients with Parkinson's disease (PWP) display aberrant synchronized oscillatory activity within the beta frequency range. Additionally, enhanced gamma oscillations may serve as a compensatory mechanism for motor inhibition mediated by beta activity and also reinstate plasticity in the primary motor cortex affected by Parkinson's disease. Transcranial alternating current stimulation (tACS) can synchronize endogenous oscillations with exogenous rhythms, thereby modulating cortical activity. The objective of this study is to investigate whether the addition of tACS to multidisciplinary intensive rehabilitation treatment (MIRT) can improve symptoms of PWP so as to enhance the quality of life in individuals with Parkinson's disease based on the central-peripheral-central theory. METHODS The present study was a randomized, double-blind trial that enrolled 60 individuals with Parkinson's disease aged between 45 and 70 years, who had Hoehn-Yahr scale scores ranging from 1 to 3. Participants were randomly assigned in a 1:1 ratio to either the tACS + MIRT group or the sham-tACS + MIRT group. The trial consisted of a two-week double-blind treatment period followed by a 24-week follow-up period, resulting in a total duration of twenty-six weeks. The primary outcome measured the change in PDQ-39 scores from baseline (T0) to 4 weeks (T2), 12 weeks (T3), and 24 weeks (T4) after completion of the intervention. The secondary outcome assessed changes in MDS-UPDRS III scores at T0, the end of intervention (T1), T2, T3, and T4. Additional clinical assessments and mechanistic studies were conducted as tertiary outcomes. DISCUSSION The objective of this study is to demonstrate that tACS can enhance overall functionality and improve quality of life in PWP, based on the framework of MIRT. Additionally, it seeks to establish a potential correlation between these therapeutic effects and neuroplasticity alterations in relevant brain regions. The efficacy of tACS will be assessed during the follow-up period in order to optimize neuroplasticity and enhance its potential impact on rehabilitation efficiency for PWP. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300071969. Registered on 30 May 2023.
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Affiliation(s)
- Hong-Yu Zhang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
- Capital Medical University, Beijing, China
| | - Ting-Ting Hou
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
- Capital Medical University, Beijing, China
| | - Zhao-Hui Jin
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
| | - Tian Zhang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
- Capital Medical University, Beijing, China
| | - Yi-Heng Wang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
- Capital Medical University, Beijing, China
| | - Zi-Hao Cheng
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
- Capital Medical University, Beijing, China
| | - Yong-Hong Liu
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
| | - Jin-Ping Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
| | - Hong-Jiao Yan
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
| | - Yi Zhen
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
| | - Xia An
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
| | - Jia Du
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
| | - Ke-Ke Chen
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
| | - Zhen-Zhen Li
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
| | - Qing Li
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
| | - Qi-Ping Wen
- Radiology Department, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China
| | - Bo-Yan Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Badachu, Xixiazhuang, Shijingshan District, Bejing, 100144, China.
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Alashram AR, Janada Q, Ghrear T. Noninvasive brain stimulation for spasticity rehabilitation in multiple sclerosis: A systematic review of randomized controlled trials. PM R 2024; 16:268-277. [PMID: 37574913 DOI: 10.1002/pmrj.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/29/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To investigate the effects of noninvasive brain stimulation (NIBS) on spasticity in people with multiple sclerosis (PwMS). LITERATURE SURVEY We searched PubMed, SCOPUS, MEDLINE, REHABDATA, PEDro, CINAHL, AMED, and Web of Science until December 2022. METHODOLOGY Studies were selected if they included PwMS, used transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) as a main intervention, and were randomized controlled trials (RCTs) including at least one outcome measure evaluating spasticity. Two researchers individually screened the selected studies. The study's quality was assessed using the Cochrane Collaborations tool. The researchers decided that the meta-analysis was not possible because the treatment interventions varied among the selected studies. SYNTHESIS In total, 147 studies were reviewed. Of them, nine studies met the eligibility criteria and included 193 PwMS (mean age = 43.2 years), 54.4% of whom were female. Eight studies were considered "high" quality and one was considered "moderate" quality. Seven studies that used rTMS demonstrated a significant decrease in spasticity in PwMS after the intervention. The remaining studies that provided tDCS did not show meaningful effects. CONCLUSIONS The evidence for the influences of rTMS on spasticity in PwMS is promising. The evidence for the impact of tDCS on spasticity in PwMS was limited. Further RCTs with long-term follow-ups are encouraged.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Qusai Janada
- Department of Physiotherapy, Middle East University, Amman, Jordan
| | - Tamara Ghrear
- Department of Physiotherapy, Middle East University, Amman, Jordan
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Galaz Prieto F, Samavaki M, Pursiainen S. Lattice layout and optimizer effect analysis for generating optimal transcranial electrical stimulation (tES) montages through the metaheuristic L1L1 method. Front Hum Neurosci 2024; 18:1201574. [PMID: 38487104 PMCID: PMC10937538 DOI: 10.3389/fnhum.2024.1201574] [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: 04/06/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction This study focuses on broadening the applicability of the metaheuristic L1-norm fitted and penalized (L1L1) optimization method in finding a current pattern for multichannel transcranial electrical stimulation (tES). The metaheuristic L1L1 optimization framework defines the tES montage via linear programming by maximizing or minimizing an objective function with respect to a pair of hyperparameters. Methods In this study, we explore the computational performance and reliability of different optimization packages, algorithms, and search methods in combination with the L1L1 method. The solvers from Matlab R2020b, MOSEK 9.0, Gurobi Optimizer, CVX's SeDuMi 1.3.5, and SDPT3 4.0 were employed to produce feasible results through different linear programming techniques, including Interior-Point (IP), Primal-Simplex (PS), and Dual-Simplex (DS) methods. To solve the metaheuristic optimization task of L1L1, we implement an exhaustive and recursive search along with a well-known heuristic direct search as a reference algorithm. Results Based on our results, and the given optimization task, Gurobi's IP was, overall, the preferable choice among Interior-Point while MOSEK's PS and DS packages were in the case of Simplex methods. These methods provided substantial computational time efficiency for solving the L1L1 method regardless of the applied search method. Discussion While the best-performing solvers show that the L1L1 method is suitable for maximizing either focality and intensity, a few of these solvers could not find a bipolar configuration. Part of the discrepancies between these methods can be explained by a different sensitivity with respect to parameter variation or the resolution of the lattice provided.
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Affiliation(s)
- Fernando Galaz Prieto
- Computing Sciences, Faculty of Information Technology, Tampere University, Tampere, Finland
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Hong JK, Yoon IY. Efficacy of cranial electrotherapy stimulation on mood and sense of well-being in people with subclinical insomnia. J Sleep Res 2024; 33:e13978. [PMID: 37366366 DOI: 10.1111/jsr.13978] [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: 01/12/2023] [Revised: 04/27/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
Cranial electrotherapy stimulation is a non-invasive brain stimulation method characterised by using a microcurrent. The objective of the study was to investigate whether a novel device with a stable supplement of electronic stimulation would improve sleep and the accompanying mood symptoms in people with subclinical insomnia. People who had insomnia symptoms without meeting the criteria for chronic insomnia disorder were recruited and randomly assigned to an active or a sham device group. They were required to use the provided device for 30 min each time, twice a day for 2 weeks. Outcome measures included questionnaires for sleep, depression, anxiety, and quality of life, 4 day actigraphy, and 64-channel electroencephalography. Fifty-nine participants (male 35.6%) with a mean age of 41.1 ± 12.0 years were randomised. Improvement of depression (p = 0.032) and physical well-being (p = 0.041) were significant in the active device group compared with the sham device group. Anxiety was also improved in the active device group, although the improvement was not statistically significant (p = 0.090). Regarding sleep, both groups showed a significant improvement in subjective rating, showing no significant group difference. The change in electroencephalography after the 2 week intervention was significantly different between the two groups, especially for occipital delta (p = 0.008) and beta power (p = 0.012), and temporo-parieto-occipital theta (p = 0.022). In conclusion, cranial electrotherapy stimulation can serve as an adjunctive therapy to ameliorate psychological symptoms and to alter brain activity. The effects of the device in a clinical population and an optimal set of parameters of stimulation should be further investigated.
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Affiliation(s)
- Jung Kyung Hong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - In-Young Yoon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
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Min Q, Gao Y, Wang Y. Bioelectricity in dental medicine: a narrative review. Biomed Eng Online 2024; 23:3. [PMID: 38172866 PMCID: PMC10765628 DOI: 10.1186/s12938-023-01189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Bioelectric signals, whether exogenous or endogenous, play crucial roles in the life processes of organisms. Recently, the significance of bioelectricity in the field of dentistry is steadily gaining greater attention. OBJECTIVE This narrative review aims to comprehensively outline the theory, physiological effects, and practical applications of bioelectricity in dental medicine and to offer insights into its potential future direction. It attempts to provide dental clinicians and researchers with an electrophysiological perspective to enhance their clinical practice or fundamental research endeavors. METHODS An online computer search for relevant literature was performed in PubMed, Web of Science and Cochrane Library, with the keywords "bioelectricity, endogenous electric signal, electric stimulation, dental medicine." RESULTS Eventually, 288 documents were included for review. The variance in ion concentration between the interior and exterior of the cell membrane, referred to as transmembrane potential, forms the fundamental basis of bioelectricity. Transmembrane potential has been established as an essential regulator of intercellular communication, mechanotransduction, migration, proliferation, and immune responses. Thus, exogenous electric stimulation can significantly alter cellular action by affecting transmembrane potential. In the field of dental medicine, electric stimulation has proven useful for assessing pulp condition, locating root apices, improving the properties of dental biomaterials, expediting orthodontic tooth movement, facilitating implant osteointegration, addressing maxillofacial malignancies, and managing neuromuscular dysfunction. Furthermore, the reprogramming of bioelectric signals holds promise as a means to guide organism development and intervene in disease processes. Besides, the development of high-throughput electrophysiological tools will be imperative for identifying ion channel targets and precisely modulating bioelectricity in the future. CONCLUSIONS Bioelectricity has found application in various concepts of dental medicine but large-scale, standardized, randomized controlled clinical trials are still necessary in the future. In addition, the precise, repeatable and predictable measurement and modulation methods of bioelectric signal patterns are essential research direction.
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Affiliation(s)
- Qingqing Min
- Department of Endodontics, Wuxi Stomatology Hospital, Wuxi, 214000, China
| | - Yajun Gao
- Department of Endodontics, Wuxi Stomatology Hospital, Wuxi, 214000, China
| | - Yao Wang
- Department of Implantology, Wuxi Stomatology Hospital, Wuxi, 214000, China.
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Hohenester M, Langguth B, Wetter TC, Geisler P, Schecklmann M, Reissmann A. Single sessions of transcranial direct current stimulation and transcranial random noise stimulation exert no effect on sleepiness in patients with narcolepsy and idiopathic hypersomnia. Front Psychiatry 2023; 14:1288976. [PMID: 38146280 PMCID: PMC10749348 DOI: 10.3389/fpsyt.2023.1288976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023] Open
Abstract
Background Hypersomnia poses major challenges to treatment providers given the limitations of available treatment options. In this context, the application of non-invasive brain stimulation techniques such as transcranial electrical stimulation (tES) may open up new avenues to effective treatment. Preliminary evidence suggests both acute and longer-lasting positive effects of transcranial direct current stimulation (tDCS) on vigilance and sleepiness in hypersomniac patients. Based on these findings, the present study sought to investigate short-term effects of single sessions of tDCS and transcranial random noise stimulation (tRNS) on sleepiness in persons suffering from hypersomnia. Methods A sample of 29 patients suffering from narcolepsy or idiopathic hypersomnia (IH) was recruited from the Regensburg Sleep Disorder Center and underwent single sessions of tES (anodal tDCS, tRNS, sham) over the left and right dorsolateral prefrontal cortex on three consecutive days in a double-blind, sham-controlled, pseudorandomized crossover trial. The primary study endpoint was the mean reaction time measured by the Psychomotor Vigilance Task (PVT) before and directly after the daily tES sessions. Secondary endpoints were additional PVT outcome metrics as well as subjective outcome parameters (e.g., Karolinska Sleepiness Scale; KSS). Results There were no significant treatment effects neither on objective (i.e., PVT) nor on subjective indicators of sleepiness. Conclusion We could not demonstrate any clinically relevant effects of single sessions of tDCS or tRNS on objective or subjective measures of sleepiness in patients with hypersomnia. However, we cannot exclude that repeated sessions of tES may affect vigilance or sleepiness in hypersomniac patients.
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Affiliation(s)
- Michaela Hohenester
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Department of Hematology and Oncology, Krankenhaus der Barmherzigen Brüder Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | | | - Peter Geisler
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Andreas Reissmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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Krone LB, Fehér KD, Rivero T, Omlin X. Brain stimulation techniques as novel treatment options for insomnia: A systematic review. J Sleep Res 2023; 32:e13927. [PMID: 37202368 PMCID: PMC10909439 DOI: 10.1111/jsr.13927] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
Despite the success of cognitive behavioural therapy for insomnia and recent advances in pharmacotherapy, many patients with insomnia do not sufficiently respond to available treatments. This systematic review aims to present the state of science regarding the use of brain stimulation approaches in treating insomnia. To this end, we searched MEDLINE, Embase and PsycINFO from inception to 24 March 2023. We evaluated studies that compared conditions of active stimulation with a control condition or group. Outcome measures included standardized insomnia questionnaires and/or polysomnography in adults with a clinical diagnosis of insomnia. Our search identified 17 controlled trials that met inclusion criteria, and assessed a total of 967 participants using repetitive transcranial magnetic stimulation, transcranial electric stimulation, transcutaneous auricular vagus nerve stimulation or forehead cooling. No trials using other techniques such as deep brain stimulation, vestibular stimulation or auditory stimulation met the inclusion criteria. While several studies report improvements of subjective and objective sleep parameters for different repetitive transcranial magnetic stimulation and transcranial electric stimulation protocols, important methodological limitations and risk of bias limit their interpretability. A forehead cooling study found no significant group differences in the primary endpoints, but better sleep initiation in the active condition. Two transcutaneous auricular vagus nerve stimulation trials found no superiority of active stimulation for most outcome measures. Although modulating sleep through brain stimulation appears feasible, gaps in the prevailing models of sleep physiology and insomnia pathophysiology remain to be filled. Optimized stimulation protocols and proof of superiority over reliable sham conditions are indispensable before brain stimulation becomes a viable treatment option for insomnia.
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Affiliation(s)
- Lukas B. Krone
- University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
- Centre for Experimental NeurologyUniversity of BernBernSwitzerland
- Department of Physiology Anatomy and Genetics, Sir Jules Thorn Sleep and Circadian Neuroscience InstituteUniversity of OxfordOxfordUK
- The Kavli Institute for Nanoscience DiscoveryUniversity of OxfordOxfordUK
| | - Kristoffer D. Fehér
- University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
- Geneva University Hospitals (HUG), Division of Psychiatric SpecialtiesUniversity of GenevaGenevaSwitzerland
| | - Tania Rivero
- Medical LibraryUniversity Library of Bern, University of BernBernSwitzerland
| | - Ximena Omlin
- University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
- Geneva University Hospitals (HUG), Division of Psychiatric SpecialtiesUniversity of GenevaGenevaSwitzerland
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Shan Y, Wang H, Yang Y, Wang J, Zhao W, Huang Y, Wang H, Han B, Pan N, Jin X, Fan X, Liu Y, Wang J, Wang C, Zhang H, Chen S, Liu T, Yan T, Si T, Yin L, Li X, Cosci F, Zhang X, Zhang G, Gao K, Zhao G. Evidence of a large current of transcranial alternating current stimulation directly to deep brain regions. Mol Psychiatry 2023; 28:5402-5410. [PMID: 37468529 DOI: 10.1038/s41380-023-02150-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/21/2023]
Abstract
Deep brain regions such as hippocampus, insula, and amygdala are involved in neuropsychiatric disorders, including chronic insomnia and depression. Our recent reports showed that transcranial alternating current stimulation (tACS) with a current of 15 mA and a frequency of 77.5 Hz, delivered through a montage of the forehead and both mastoids was safe and effective in intervening chronic insomnia and depression over 8 weeks. However, there is no physical evidence to support whether a large alternating current of 15 mA in tACS can send electrical currents to deep brain tissue in awake humans. Here, we directly recorded local field potentials (LFPs) in the hippocampus, insula and amygdala at different current strengths (1 to 15 mA) in 11 adult patients with drug-resistant epilepsy implanted with stereoelectroencephalography (SEEG) electrodes who received tACS at 77.5 Hz from 1 mA to 15 mA at 77.5 Hz for five minutes at each current for a total of 40 min. For the current of 15 mA at 77.5 Hz, additional 55 min were applied to add up a total of 60 min. Linear regression analysis revealed that the average LFPs for the remaining contacts on both sides of the hippocampus, insula, and amygdala of each patient were statistically associated with the given currents in each patient (p < 0.05-0.01), except for the left insula of one subject (p = 0.053). Alternating currents greater than 7 mA were required to produce significant differences in LFPs in the three brain regions compared to LFPs at 0 mA (p < 0.05). The differences remained significant after adjusting for multiple comparisons (p < 0.05). Our study provides direct evidence that the specific tACS procedures are capable of delivering electrical currents to deep brain tissues, opening a realistic avenue for modulating or treating neuropsychiatric disorders associated with hippocampus, insula, and amygdala.
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Affiliation(s)
- Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
- China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, China
| | - Hongxing Wang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China.
- Beijing Institute of Brain Disorders, Beijing, 100069, China.
| | - Yanfeng Yang
- Department of Neurosurgery, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
- China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, China
| | - Jiahao Wang
- Beijing Key Laboratory of Bioelectromagnetism, Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Wenfeng Zhao
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Yuda Huang
- Department of Neurosurgery, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
- China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, China
| | - Huang Wang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Bing Han
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Na Pan
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Xiukun Jin
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Xiaotong Fan
- Department of Neurosurgery, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
- China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, China
| | - Yunyun Liu
- Department of Neurosurgery, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
- China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, China
| | - Jun Wang
- Department of Neurosurgery, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
- China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, China
| | - Changming Wang
- Department of Neurosurgery, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
- China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, China
| | - Huaqiang Zhang
- Department of Neurosurgery, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
- China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, China
| | - Sichang Chen
- Department of Neurosurgery, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
- China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, China
| | - Ting Liu
- Department of Neurosurgery, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
- China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, China
| | - Tianyi Yan
- School of Life Science, Beijing Institute of Technology, Beijing, 100081, China
| | - Tianmei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, 100191, China
| | - Lu Yin
- Medical Research & Biometrics Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 102300, China
| | - Xinmin Li
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Albert, T6G 2B7, Canada
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, 50135, Italy.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing, 100101, China.
| | - Guanghao Zhang
- Beijing Key Laboratory of Bioelectromagnetism, Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, 100190, China.
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Keming Gao
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA.
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China.
- China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China.
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, China.
- Center of Epilepsy, Beijing Institute of Brain Disorders, Beijing, 100069, China.
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12
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Vasu SO, Kaphzan H. Direct Current Stimulation Modulates Synaptic Facilitation via Distinct Presynaptic Calcium Channels. Int J Mol Sci 2023; 24:16866. [PMID: 38069188 PMCID: PMC10706473 DOI: 10.3390/ijms242316866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is a subthreshold neurostimulation technique known for ameliorating neuropsychiatric conditions. The principal mechanism of tDCS is the differential polarization of subcellular neuronal compartments, particularly the axon terminals that are sensitive to external electrical fields. Yet, the underlying mechanism of tDCS is not fully clear. Here, we hypothesized that direct current stimulation (DCS)-induced modulation of presynaptic calcium channel conductance alters axon terminal dynamics with regard to synaptic vesicle release. To examine the involvement of calcium-channel subtypes in tDCS, we recorded spontaneous excitatory postsynaptic currents (sEPSCs) from cortical layer-V pyramidal neurons under DCS while selectively inhibiting distinct subtypes of voltage-dependent calcium channels. Blocking P/Q or N-type calcium channels occluded the effects of DCS on sEPSCs, demonstrating their critical role in the process of DCS-induced modulation of spontaneous vesicle release. However, inhibiting T-type calcium channels did not occlude DCS-induced modulation of sEPSCs, suggesting that despite being active in the subthreshold range, T-type calcium channels are not involved in the axonal effects of DCS. DCS modulates synaptic facilitation by regulating calcium channels in axon terminals, primarily via controlling P/Q and N-type calcium channels, while T-type calcium channels are not involved in this mechanism.
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Affiliation(s)
| | - Hanoch Kaphzan
- Sagol Department of Neurobiology, University of Haifa, Haifa 3103301, Israel
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13
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Alashram AR, Padua E, Annino G. Noninvasive brain stimulation for cognitive rehabilitation following traumatic brain injury: A systematic review. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:814-829. [PMID: 35771044 DOI: 10.1080/23279095.2022.2091440] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Traumatic brain injury (TBI) can cause numerous cognitive deficits. These deficits are associated with disability and reduction in quality of life. Noninvasive brain stimulation (NIBS) provides excitatory or inhibitory stimuli to the cerebral cortex. This review aimed to examine the effectiveness of NIBS (i.e., rTMS and tDCS) on cognitive functions in patients with TBI. PubMed, SCOPUS, PEDro, CINAHL, MEDLINE, REHABDATA, and Web of Science were searched from inception to May 2021. The risk of bias in the randomized controlled trials was assessed using the Cochrane Collaboration's instrument. The Physiotherapy Evidence Database (PEDro) scale was applied to evaluate the risk of bias in the non-randomized controlled trials. Ten studies met our inclusion criteria. Six studies used repetitive Transcranial Magnetic Stimulation (rTMS), and four used transcranial Direct Current Stimulation (tDCS) as cognitive rehabilitation interventions. The results showed heterogenous evidence for the effects of rTMS and tDCS on cognitive function outcomes in individuals with TBI. The evidence for the effects of NIBS on cognition following TBI was limited. TDCS and rTMS are safe and well-tolerated interventions post-TBI. The optimal stimulation sites and stimulation parameters remain unknown. Combining NIBS with traditional rehabilitation interventions may contribute to greater enhancements in cognitive functions post-TBI.
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Affiliation(s)
| | - Elvira Padua
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Giuseppe Annino
- Department of Medicine Systems, University of Rome "Tor Vergata", Rome, Italy
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Pollok B, Depperschmidt C, Koester M, Schmidt-Wilcke T, Krause V. Cathodal high-definition transcranial direct current stimulation (HD-tDCS) of the left ventral prefrontal cortex (vPFC) interferes with conscious error correction. Behav Brain Res 2023; 454:114661. [PMID: 37696453 DOI: 10.1016/j.bbr.2023.114661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
Precise motor timing requires the ability to flexibly adapt one's own movements with respect to changes in the environment. Previous studies suggest that the correction of perceived as compared to non-perceived timing errors involves at least partially distinct brain networks. The dorsolateral prefrontal cortex (dPFC) has been linked to the correction of perceived timing errors and evidence for a contribution of the ventrolateral PFC (vPFC) specifically to the correction of non-perceived errors exists. The present study aimed at clarifying the functional contribution of the left vPFC for the correction of timing errors by adopting high-definition transcranial direct current stimulation (HD-tDCS). Twenty-one young healthy volunteers synchronized their right index finger taps with respect to an isochronous auditory pacing signal. Perceivable and non-perceivable step-changes of the metronome were interspersed, and error correction was analyzed by means of the phase-correction response (PCR). In subsequent sessions anodal and cathodal HD-tDCS was applied to the left vPFC to establish a brain-behavior relationship. Sham stimulation served as control condition. Synchronization accuracy as well as error correction were determined immediately prior to and after HD-tDCS. The analysis suggests a detrimental effect of cathodal HD-tDCS distinctively on error correction in trials with perceived timing errors. The data support the significance of the left vPFC for error correction in the temporal domain but contradicts the view of a role in the correction of non-perceived errors.
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Affiliation(s)
- Bettina Pollok
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany.
| | - Carina Depperschmidt
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Maximilian Koester
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Tobias Schmidt-Wilcke
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany; Center of Neurology, District Hospital Mainkofen, 94469 Deggendorf, Germany
| | - Vanessa Krause
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany; Department of Neuropsychology, Mauritius Hospital and Neurorehabilitation Center Meerbusch, 40670 Meerbusch, Germany
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15
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Bao C, Wei M, Pan H, Wen M, Liu Z, Xu Y, Jiang H. A preliminary study for the clinical effect of one combinational physiotherapy and its potential influence on gut microbial composition in children with Tourette syndrome. Front Nutr 2023; 10:1184311. [PMID: 37781119 PMCID: PMC10541309 DOI: 10.3389/fnut.2023.1184311] [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: 03/17/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Tourette syndrome (TS) is a chronic neuropsychiatric disorder with unknown causes and inadequate therapies. Inspired by the important roles of gut microbiota in some mental illnesses, the interactions between gut microbiota and TS via the gut-brain axis have gained more and more attention. This study aimed to characterize the gut microbial profiles in children with TS, and explore the clinical effects of one combinational physiotherapy and its potential influence on gut microbial composition. Methods The gut microbial profiles were depicted based on the sequence data of 32 patients and 29 matched health children by 16S rDNA amplicon pyrosequencing. Thirty of thirty-two patients underwent uninterrupted two 10-day courses of combinational physiotherapy, which included a 60-minute cranial electrotherapy stimulation (CES) training followed by a 30-minute biofeedback training per session, 2 sessions a day. Results Our results indicated that the gut microbial composition in children with TS was different from that in healthy controls. Multiple GBM neurotransmitter modules obtained through Picrust2 functional predictive analysis were significantly increased in patients, including Histamine degradation, Dopamine degradation, and DOPAC synthesis. Moreover, this combinational physiotherapy could significantly diminish tic activity, whose positive effects were first reported in children with TS. Lastly, different gut microbial compositions and predictive metabolic pathways were also observed between patients before and after this treatment, with lower abundances of the genera (e.g., Dorea) and significant decreases of GBM neurotransmitter modules (e.g. dopamine degradation) in patients after this treatment, indicating that improved clinical symptoms might be accompanied by an improvement of intestinal microenvironment. Discussion Children with TS showed a cognizable gut microbial profile, and certain enriched bacteria with pro-inflammatory potential might induce neuroinflammatory responses. This combinational physiotherapy could significantly diminish tic activity, and the gut microbial compositions in patients after this treatment were different from those without any treatment, indicating the existence of bidirectional communication of the gut-brain axis in TS. But studies on the gut microbial characteristics in TS patients, the influences of gut microbiota on tic severity, the efficacy and safety of this treatment, and the bidirectional regulatory mechanism between brain signals and gut microbiota in TS still need to be explored.
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Affiliation(s)
- Chun Bao
- Department of Child Healthcare, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Meng Wei
- Department of Child Healthcare, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Hongguo Pan
- Department of Child Healthcare, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Ming Wen
- Zhangjiang Center for Translational Medicine, Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai, China
| | - Ziming Liu
- Zhangjiang Center for Translational Medicine, Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai, China
| | - Yue Xu
- Zhangjiang Center for Translational Medicine, Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai, China
| | - Huihui Jiang
- Zhangjiang Center for Translational Medicine, Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai, China
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16
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Pan R, Ye S, Zhong Y, Chen Q, Cai Y. Transcranial alternating current stimulation for the treatment of major depressive disorder: from basic mechanisms toward clinical applications. Front Hum Neurosci 2023; 17:1197393. [PMID: 37731669 PMCID: PMC10507344 DOI: 10.3389/fnhum.2023.1197393] [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: 03/31/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Non-pharmacological treatment is essential for patients with major depressive disorder (MDD) that is medication resistant or who are unable to take medications. Transcranial alternating current stimulation (tACS) is a non-invasive brain stimulation method that manipulates neural oscillations. In recent years, tACS has attracted substantial attention for its potential as an MDD treatment. This review summarizes the latest advances in tACS treatment for MDD and outlines future directions for promoting its clinical application. We first introduce the neurophysiological mechanism of tACS and its novel developments. In particular, two well-validated tACS techniques have high application potential: high-definition tACS targeting local brain oscillations and bifocal tACS modulating interarea functional connectivity. Accordingly, we summarize the underlying mechanisms of tACS modulation for MDD. We sort out the local oscillation abnormalities within the reward network and the interarea oscillatory synchronizations among multiple MDD-related networks in MDD patients, which provide potential modulation targets of tACS interventions. Furthermore, we review the latest clinical studies on tACS treatment for MDD, which were based on different modulation mechanisms and reported alleviations in MDD symptoms. Finally, we discuss the main challenges of current tACS treatments for MDD and outline future directions to improve intervention target selection, tACS implementation, and clinical validations.
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Affiliation(s)
- Ruibo Pan
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shengfeng Ye
- Department of Psychology and Behavioral Science, Zhejiang University, Hangzhou, China
| | - Yun Zhong
- Department of Psychology and Behavioral Science, Zhejiang University, Hangzhou, China
| | - Qiaozhen Chen
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Ying Cai
- Department of Psychology and Behavioral Science, Zhejiang University, Hangzhou, China
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17
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Chikhi S, Matton N, Sanna M, Blanchet S. Mental strategies and resting state EEG: Effect on high alpha amplitude modulation by neurofeedback in healthy young adults. Biol Psychol 2023; 178:108521. [PMID: 36801435 DOI: 10.1016/j.biopsycho.2023.108521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/30/2022] [Accepted: 02/15/2023] [Indexed: 02/19/2023]
Abstract
Neurofeedback (NFB) is a brain-computer interface which allows individuals to modulate their brain activity. Despite the self-regulatory nature of NFB, the effectiveness of strategies used during NFB training has been little investigated. In a single session of NFB training (6*3 min training blocks) with healthy young participants, we experimentally tested if providing a list of mental strategies (list group, N = 46), compared with a group receiving no strategies (no list group, N = 39), affected participants' neuromodulation ability of high alpha (10-12 Hz) amplitude. We additionally asked participants to verbally report the mental strategies used to enhance high alpha amplitude. The verbatim was then classified in pre-established categories in order to examine the effect of type of mental strategy on high alpha amplitude. First, we found that giving a list to the participants did not promote the ability to neuromodulate high alpha activity. However, our analysis of the specific strategies reported by learners during training blocks revealed that cognitive effort and recalling memories were associated with higher high alpha amplitude. Furthermore, the resting amplitude of trained high alpha frequency predicted an amplitude increase during training, a factor that may optimize inclusion in NFB protocols. The present results also corroborate the interrelation with other frequency bands during NFB training. Although these findings are based on a single NFB session, our study represents a further step towards developing effective protocols for high alpha neuromodulation by NFB.
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Affiliation(s)
- Samy Chikhi
- Université Paris Cité, Laboratoire Mémoire, Cerveau et Cognition, F-92100 Boulogne-Billancourt, France
| | - Nadine Matton
- CLLE, Université de Toulouse, CNRS (UMR 5263), Toulouse, France; ENAC, École Nationale d'Aviation Civile, Université de Toulouse, France
| | - Marie Sanna
- Université Paris Cité, Laboratoire Mémoire, Cerveau et Cognition, F-92100 Boulogne-Billancourt, France
| | - Sophie Blanchet
- Université Paris Cité, Laboratoire Mémoire, Cerveau et Cognition, F-92100 Boulogne-Billancourt, France.
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Cranial electrotherapy stimulation alleviates depression-like behavior of post-stroke depression rats by upregulating GPX4-mediated BDNF expression. Behav Brain Res 2023; 437:114117. [PMID: 36116735 DOI: 10.1016/j.bbr.2022.114117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022]
Abstract
To elucidate whether cranial electrotherapy stimulation (CES) improves depression-like behavior of post-stroke depression (PSD) via regulation of glutathione peroxidase 4 (GPX4)-mediated brain-derived neurotrophic factor (BDNF) expression. Middle cerebral artery occlusion (MCAO) and chronic unpredictable mild stress (CUMS) were used to develop a rat PSD model. CES was applied, and RAS-selective lethal 3 (RSL3) was injected into the hippocampus to inhibit GPX4 in PSD rats. The depression behavior was detected by sucrose preference and forced swimming tests. The structure and morphology of the hippocampus were observed and analyzed by histopathological hematoxylin-eosin (HE) staining. The mRNA and protein expressions of GPX4 and BDNF in the hippocampus were detected by qRT-PCR, western blot and immunohistochemical analysis.The degeneration and necrosis of hippocampal neurons, the depression-like behavior were severer and the expression of BDNF in the hippocampus were decreased in PSD rats than those in MCAO and control groups. CES promoted the hippocampal neuron repair, alleviated the depression-like behavior and increased the expression of BDNF in PSD rats. The inhibition of GPX4 by RSL3 exacerbated the depression-like behavior and decreased the expression of BDNF in PSD rats. In addition, we found that RSL3 disrupted the positive effects of CES on the PSD rats. Conclusion: CES improves depression-like behavior of PSD rats through upregulation of GPX4-mediated BDNF expression in the hippocampus.
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Alashram AR, Padua E, Aburub A, Raju M, Annino G. Transcranial direct current stimulation for upper extremity spasticity rehabilitation in stroke survivors: A systematic review of randomized controlled trials. PM R 2023; 15:222-234. [PMID: 35286007 DOI: 10.1002/pmrj.12804] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To examine the effects of transcranial direct current stimulation (tDCS) on upper extremity spasticity after stroke and to define the most effective tDCS parameters. LITERATURE SURVEY Systematic review in the following databases: PubMed, SCOPUS, PEDro, CINAHL, MEDLINE, REHABDATA, AMED, and Web of Science databases. Studies up to June 2020 were included. METHODOLOGY Studies were included if the sample was composed of individuals with stroke, the intervention followed a tDCS intervention (alone or combined with another intervention), and the study was a randomized controlled trial including at least one measurement assessing upper extremity spasticity. Two authors independently screened the included studies. Conflicting decisions between authors were resolved by discussion with the third author. The methodological quality was assessed using the Cochrane Collaboration's tool. The authors determined that the meta-analysis was not feasible due to the heterogeneity in the protocols among the included studies. SYNTHESIS After the screening of 1204 records, a total of seven studies met the specified inclusion criteria and involved 320 participants (mean age = 60.3), 31.1% of whom were females. Patients with ischemic stroke comprised 77.2% of the total patients, and 42.2% were with right hemispheric stroke. Six studies exhibited "high" quality and one exhibited "moderate" quality. Five of the selected studies that combined the tDCS intervention and other traditional interventions showed a significant reduction in upper extremity spasticity after stroke following tDCS intervention. The other two studies that delivered tDCs alone did not show a significant difference. CONCLUSIONS The evidence for the effect of tDCS on upper extremity spasticity after stroke was limited. The optimal tDCS treatment dosage remains unclear. Additional studies with large sample sizes and long-term follow-up are strongly warranted.
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Affiliation(s)
| | - Elvira Padua
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Aseel Aburub
- Department of Physiotherapy, Isra University, Amman, Jordan
| | - Manikandan Raju
- Clinical/Experimental Neuroscience and Psychology, Department of Neuroscience Umane, University of Sapienza, Rome, Italy
| | - Giuseppe Annino
- Department of Medicine Systems, University of Rome "Tor Vergata", Rome, Italy
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20
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Guimarães AN, Porto AB, Marcori AJ, Lage GM, Altimari LR, Alves Okazaki VH. Motor learning and tDCS: A systematic review on the dependency of the stimulation effect on motor task characteristics or tDCS assembly specifications. Neuropsychologia 2023; 179:108463. [PMID: 36567006 DOI: 10.1016/j.neuropsychologia.2022.108463] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/21/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
TDCS is one of the most commonly used methods among studies with transcranial electrical stimulation and motor skills learning. Differences between study results suggest that the effect of tDCS on motor learning is dependent on the motor task performed or on the tDCS assembly specification used in the learning process. This systematic review aimed to analyze the tDCS effect on motor learning and verify whether this effect is dependent on the task or tDCS assembly specifications. Searches were performed in PubMed, SciELO, LILACS, Web of Science, CINAHL, Scopus, SPORTDiscus, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and PsycINFO. Articles were included that analyzed the effect of tDCS on motor learning through pre-practice, post-practice, retention, and/or transfer tests (period ≥24 h). The tDCS was most frequently applied to the primary motor cortex (M1) or the cerebellar cortex (CC) and the majority of studies found significant stimulation effects. Studies that analyzed identical or similar motor tasks show divergent results for the tDCS effect, even when the assembly specifications are the same. The tDCS effect is not dependent on motor task characteristics or tDCS assembly specifications alone but is dependent on the interaction between these factors. This interaction occurs between uni and bimanual tasks with anodal uni and bihemispheric (bilateral) stimulations at M1 or with anodal unihemispheric stimulations (unilateral and centrally) at CC, and between tasks of greater or lesser difficulty with single or multiple tDCS sessions. Movement time seems to be more sensitive than errors to indicate the effects of tDCS on motor learning, and a sufficient amount of motor practice to reach the "learning plateau" also seems to determine the effect of tDCS on motor learning.
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Affiliation(s)
- Anderson Nascimento Guimarães
- State University of Londrina, Londrina. Rodovia Celso Garcia Cid - Pr 445, Km 380, Cx. Postal 10.011, CEP 86057-970, Campus Universitário, Londrina, PR, Brazil.
| | - Alessandra Beggiato Porto
- State University of Londrina, Londrina. Rodovia Celso Garcia Cid - Pr 445, Km 380, Cx. Postal 10.011, CEP 86057-970, Campus Universitário, Londrina, PR, Brazil.
| | - Alexandre Jehan Marcori
- University of São Paulo, Av. Professor Mello Moraes 65, CEP 05508-030, Vila Universitaria, São Paulo, SP, Brazil.
| | - Guilherme Menezes Lage
- Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, CEP 31270-901, Belo Horizonte, MG, Brazil.
| | - Leandro Ricardo Altimari
- State University of Londrina, Londrina. Rodovia Celso Garcia Cid - Pr 445, Km 380, Cx. Postal 10.011, CEP 86057-970, Campus Universitário, Londrina, PR, Brazil.
| | - Victor Hugo Alves Okazaki
- State University of Londrina, Londrina. Rodovia Celso Garcia Cid - Pr 445, Km 380, Cx. Postal 10.011, CEP 86057-970, Campus Universitário, Londrina, PR, Brazil.
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21
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Bakhshayesh Eghbali B, Ramezani S, Sedaghat Herfeh S, Emir Alavi C, Najafi K, Esmaeeli Lipaei P, Eslamparast Kordmahalleh S, Hosseinpour Sarmadi V, Amini N, Ramezani Kapourchali F. ¬Transcranial direct current stimulation improves sleep quality in patients with insomnia after traumatic brain injury. Brain Inj 2023; 37:63-73. [PMID: 36408966 DOI: 10.1080/02699052.2022.2145363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Insomnia is a serious problem after traumatic brain injury (TBI) and partially improves via sleeping pills. We investigated the efficacy of transcranial direct current stimulation (tDCS) with a focus on the role of age and gender. MATERIALS AND METHODS In a randomized double-blind clinical trial, 60 eligible TBI-induced insomnia patients were assigned to real and sham tDCS groups and were treated for three weeks. Sham but not real tDCS took sleeping pills for the first three weeks of the study and then used the placebo until the end of the study. The placebo was used by the real-tDCS group throughout the study. Sleep quality and insomnia severity were respectively evaluated by Pittsburg Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) at three time points. RESULTS Real tDCS group reported lower mean ISI and PSQI scores at 3 weeks post treatment onset and maintained this decline for six weeks post treatment onset (P < 0.001). In younger participants and those identified as men, the treatment-induced attenuation of the mean PSQI score was reported higher and more lasting in real than sham tDCS groups. CONCLUSION Gender and age-specific tDCS protocols may be warranted to optimize the therapeutic effect of tDCS.
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Affiliation(s)
- Babak Bakhshayesh Eghbali
- Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Sara Ramezani
- Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Sina Sedaghat Herfeh
- Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Cyrus Emir Alavi
- Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Kiomars Najafi
- Kavosh Research Center for Behavioral-Cognitive Sciences and Addiction, Department of Noninvasive Brain Stimulation, Tolou Clinic Guilan University of Medical Sciences, Rasht, Iran
| | - Pedram Esmaeeli Lipaei
- Student Research Committee, Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Vahid Hosseinpour Sarmadi
- Cellular and Molecular Research Centre, Iran University of Medical Sciences, Tehran, Iran.,Institutes of Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Naser Amini
- Cellular and Molecular Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ramezani Kapourchali
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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22
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Sansevere KS, Wooten T, McWilliams T, Peach S, Hussey EK, Brunyé TT, Ward N. Self-reported Outcome Expectations of Non-invasive Brain Stimulation Are Malleable: a Registered Report that Replicates and Extends Rabipour et al. (2017). JOURNAL OF COGNITIVE ENHANCEMENT 2022. [DOI: 10.1007/s41465-022-00250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Hong KS, Khan MNA, Ghafoor U. Non-invasive transcranial electrical brain stimulation guided by functional near-infrared spectroscopy for targeted neuromodulation: A review. J Neural Eng 2022; 19. [PMID: 35905708 DOI: 10.1088/1741-2552/ac857d] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/29/2022] [Indexed: 11/12/2022]
Abstract
One of the primary goals in cognitive neuroscience is to understand the neural mechanisms on which cognition is based. Researchers are trying to find how cognitive mechanisms are related to oscillations generated due to brain activity. The research focused on this topic has been considerably aided by developing non-invasive brain stimulation techniques. The dynamics of brain networks and the resultant behavior can be affected by non-invasive brain stimulation techniques, which make their use a focus of interest in many experiments and clinical fields. One essential non-invasive brain stimulation technique is transcranial electrical stimulation (tES), subdivided into transcranial direct and alternating current stimulation. tES has recently become more well-known because of the effective results achieved in treating chronic conditions. In addition, there has been exceptional progress in the interpretation and feasibility of tES techniques. Summarizing the beneficial effects of tES, this article provides an updated depiction of what has been accomplished to date, brief history, and the open questions that need to be addressed in the future. An essential issue in the field of tES is stimulation duration. This review briefly covers the stimulation durations that have been utilized in the field while monitoring the brain using functional-near infrared spectroscopy-based brain imaging.
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Affiliation(s)
- Keum-Shik Hong
- Department of Cogno-mechatronics Engineering, Pusan National University, 2 Busandaehak-ro, Geumgeong-gu, Busan, Busan, 609735, Korea (the Republic of)
| | - M N Afzal Khan
- Pusan National University, Department of Mechanical Engineering, Busan, 46241, Korea (the Republic of)
| | - Usman Ghafoor
- School of Mechanical Engineering, Pusan National University College of Engineering, room 204, Busan, 46241, Korea (the Republic of)
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24
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Fusco G, Cristiano A, Perazzini A, Aglioti SM. Neuromodulating the performance monitoring network during conflict and error processing in healthy populations: Insights from transcranial electric stimulation studies. Front Integr Neurosci 2022; 16:953928. [PMID: 35965598 PMCID: PMC9368590 DOI: 10.3389/fnint.2022.953928] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/27/2022] [Indexed: 12/05/2022] Open
Abstract
The performance monitoring system is fundamentally important for adapting one’s own behavior in conflicting and error-prone, highly demanding circumstances. Flexible behavior requires that neuronal populations optimize information processing through efficient multi-scale communication. Non-invasive brain stimulation (NIBS) studies using transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES) fields to alter the cortical activity promise to illuminate the neurophysiological mechanisms that underpin neuro-cognitive and behavioral processing and their causal relationship. Here, we focus on the transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) that have been increasingly used in cognitive neuroscience for modulating superficial neural networks in a polarity (tDCS) and frequency/phase (tACS) fashion. Specifically, we discuss recent evidence showing how tDCS and tACS modulate the performance monitoring network in neurotypical samples. Emphasis is given to studies using behavioral tasks tapping conflict and error processing such as the Stroop, the Flanker, and the Simon tasks. The crucial role of mid-frontal brain regions (such as the medial frontal cortex, MFC; and the dorsal anterior cingulate cortex, dACC) and of theta synchronization in monitoring conflict and error is highlighted. We also discuss current technological limitations (e.g., spatial resolution) and the specific methodological strategies needed to properly modulate the cortical and subcortical regions.
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Affiliation(s)
- Gabriele Fusco
- “Sapienza” University of Rome and CLN2S@SAPIENZA, Istituto Italiano di Tecnologia, Rome, Italy
- IRCCS Santa Lucia Foundation, Rome, Italy
- *Correspondence: Gabriele Fusco,
| | - Azzurra Cristiano
- “Sapienza” University of Rome and CLN2S@SAPIENZA, Istituto Italiano di Tecnologia, Rome, Italy
- IRCCS Santa Lucia Foundation, Rome, Italy
| | - Anna Perazzini
- “Sapienza” University of Rome and CLN2S@SAPIENZA, Istituto Italiano di Tecnologia, Rome, Italy
- IRCCS Santa Lucia Foundation, Rome, Italy
| | - Salvatore Maria Aglioti
- “Sapienza” University of Rome and CLN2S@SAPIENZA, Istituto Italiano di Tecnologia, Rome, Italy
- IRCCS Santa Lucia Foundation, Rome, Italy
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25
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Cranial Electrotherapy Stimulation (CES) Does Not Reliably Influence Emotional, Physiological, Biochemical, or Behavioral Responses to Acute Stress. JOURNAL OF COGNITIVE ENHANCEMENT 2022. [DOI: 10.1007/s41465-022-00248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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26
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Perspectives on the Combined Use of Electric Brain Stimulation and Perceptual Learning in Vision. Vision (Basel) 2022; 6:vision6020033. [PMID: 35737420 PMCID: PMC9227313 DOI: 10.3390/vision6020033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022] Open
Abstract
A growing body of literature offers exciting perspectives on the use of brain stimulation to boost training-related perceptual improvements in humans. Recent studies suggest that combining visual perceptual learning (VPL) training with concomitant transcranial electric stimulation (tES) leads to learning rate and generalization effects larger than each technique used individually. Both VPL and tES have been used to induce neural plasticity in brain regions involved in visual perception, leading to long-lasting visual function improvements. Despite being more than a century old, only recently have these techniques been combined in the same paradigm to further improve visual performance in humans. Nonetheless, promising evidence in healthy participants and in clinical population suggests that the best could still be yet to come for the combined use of VPL and tES. In the first part of this perspective piece, we briefly discuss the history, the characteristics, the results and the possible mechanisms behind each technique and their combined effect. In the second part, we discuss relevant aspects concerning the use of these techniques and propose a perspective concerning the combined use of electric brain stimulation and perceptual learning in the visual system, closing with some open questions on the topic.
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27
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Olgiati E, Malhotra PA. Using non-invasive transcranial direct current stimulation for neglect and associated attentional deficits following stroke. Neuropsychol Rehabil 2022; 32:732-763. [PMID: 32892712 DOI: 10.1080/09602011.2020.1805335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neglect is a disabling neuropsychological syndrome that is frequently observed following right-hemispheric stroke. Affected individuals often present with multiple attentional deficits, ranging from reduced orienting towards contralesional space to a generalized impairment in maintaining attention over time. Although a degree of spontaneous recovery occurs in most patients, in some individuals this condition can be treatment-resistant with prominent ongoing non-spatial deficits. Further, there is a large inter-individual variability in response to different therapeutic approaches. Given its potential to alter neuronal excitability and affect neuroplasticity, non-invasive brain stimulation is a promising tool that could potentially be utilized to facilitate recovery. However, there are many outstanding questions regarding its implementation in this heterogeneous patient group. Here we provide a critical overview of the available evidence on the use of non-invasive electrical brain stimulation, focussing on transcranial direct current stimulation (tDCS), to improve neglect and associated attentional deficits after right-hemispheric stroke. At present, there is insufficient robust evidence supporting the clinical use of tDCS to alleviate symptoms of neglect. Future research would benefit from careful study design, enhanced precision of electrical montages, multi-modal approaches exploring predictors of response, tailored dose-control applications and increased efforts to evaluate standalone tDCS versus its incorporation into combination therapy.
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Affiliation(s)
- Elena Olgiati
- Department of Brain Sciences, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Paresh A Malhotra
- Department of Brain Sciences, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK.,UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, London, UK
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28
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Anodal Transcranial Direct Current Stimulation (atDCS) of the Primary Motor Cortex (M1) Facilitates Nonconscious Error Correction of Negative Phase Shifts. Neural Plast 2022; 2022:9419154. [PMID: 35662740 PMCID: PMC9159881 DOI: 10.1155/2022/9419154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
Accurate motor timing requires the temporally precise coupling between sensory input and motor output including the adjustment of movements with respect to changes in the environment. Such error correction has been related to a cerebello-thalamo-cortical network. At least partially distinct networks for the correction of perceived (i.e., conscious) as compared to nonperceived (i.e., nonconscious) errors have been suggested. While the cerebellum, the premotor, and the prefrontal cortex seem to be involved in conscious error correction, the network subserving nonconscious error correction is less clear. The present study is aimed at investigating the functional contribution of the primary motor cortex (M1) for both types of error correction in the temporal domain. To this end, anodal transcranial direct current stimulation (atDCS) was applied to the left M1 in a group of 18 healthy young volunteers during a resting period of 10 minutes. Sensorimotor synchronization as well as error correction of the right index finger was tested immediately prior to and after atDCS. Sham stimulation served as control condition. To induce error correction, nonconscious and conscious temporal step-changes were interspersed in a sequence of an isochronous auditory pacing signal in either direction (i.e., negative or positive) yielding either shorter or longer intervals. Prior to atDCS, faster error correction in conscious as compared to nonconscious trials was observed replicating previous findings. atDCS facilitated nonconscious error correction, but only in trials with negative step-changes yielding shorter intervals. In contrast to this, neither tapping speed nor synchronization performance with respect to the isochronous pacing signal was significantly modulated by atDCS. The data suggest M1 as part of a network distinctively contributing to the correction of nonconscious negative step-changes going beyond sensorimotor synchronization.
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29
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Yang QH, Zhang YH, Du SH, Wang YC, Fang Y, Wang XQ. Non-invasive Brain Stimulation for Central Neuropathic Pain. Front Mol Neurosci 2022; 15:879909. [PMID: 35663263 PMCID: PMC9162797 DOI: 10.3389/fnmol.2022.879909] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/04/2022] [Indexed: 12/15/2022] Open
Abstract
The research and clinical application of the noninvasive brain stimulation (NIBS) technique in the treatment of neuropathic pain (NP) are increasing. In this review article, we outline the effectiveness and limitations of the NIBS approach in treating common central neuropathic pain (CNP). This article summarizes the research progress of NIBS in the treatment of different CNPs and describes the effects and mechanisms of these methods on different CNPs. Repetitive transcranial magnetic stimulation (rTMS) analgesic research has been relatively mature and applied to a variety of CNP treatments. But the optimal stimulation targets, stimulation intensity, and stimulation time of transcranial direct current stimulation (tDCS) for each type of CNP are still difficult to identify. The analgesic mechanism of rTMS is similar to that of tDCS, both of which change cortical excitability and synaptic plasticity, regulate the release of related neurotransmitters and affect the structural and functional connections of brain regions associated with pain processing and regulation. Some deficiencies are found in current NIBS relevant studies, such as small sample size, difficulty to avoid placebo effect, and insufficient research on analgesia mechanism. Future research should gradually carry out large-scale, multicenter studies to test the stability and reliability of the analgesic effects of NIBS.
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Affiliation(s)
- Qi-Hao Yang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yong-Hui Zhang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Shu-Hao Du
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yu-Chen Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yu Fang
- School of Mechanical and Automotive Engineering, Shanghai University of Engineering Science, Shanghai, China
- *Correspondence: Yu Fang,
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
- Xue-Qiang Wang,
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30
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Carpenter LL, Kronenberg EF, Tirrell E, Kokdere F, Beck QM, Temereanca S, Fukuda AM, Garikapati S, Hagberg S. Mechanical Affective Touch Therapy for Anxiety Disorders: Feasibility, Clinical Outcomes, and Electroencephalography Biomarkers From an Open-Label Trial. Front Psychiatry 2022; 13:877574. [PMID: 35530031 PMCID: PMC9072623 DOI: 10.3389/fpsyt.2022.877574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Most external peripheral nerve stimulation devices designed to alter mood states use electrical energy, but mechanical stimulation for activation of somatosensory pathways may be harnessed for potential therapeutic neuromodulation. A novel investigational device for Mechanical Affective Touch Therapy (MATT) was created to stimulate C-tactile fibers through gentle vibrations delivered by piezoelectric actuators on the bilateral mastoid processes. Methods 22 adults with anxiety disorders and at least moderate anxiety symptom severity enrolled in an open-label pilot trial that involved MATT self-administration using a simple headset at home at least twice per day for 4 weeks. Resting EEG data were acquired before and after a baseline MATT session and again before the final MATT session. Self-report measures of mood and anxiety were collected at baseline, week 2, and week 4, while interoception was assessed pre- and post-treatment. Results Anxiety and depressive symptoms improved significantly from baseline to endpoint, and mindfulness was enhanced. EEG metrics confirmed an association between acute MATT stimulation and oscillatory power in alpha and theta bands; symptom changes correlated with changes in some metrics. Conclusion Open-label data suggest MATT is a promising non-invasive therapeutic approach to anxiety disorders that warrants further development.
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Affiliation(s)
- Linda L. Carpenter
- Neuromodulation Research Facility, TMS Clinic, Butler Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Eugenia F. Kronenberg
- Neuromodulation Research Facility, TMS Clinic, Butler Hospital, Providence, RI, United States
| | - Eric Tirrell
- Neuromodulation Research Facility, TMS Clinic, Butler Hospital, Providence, RI, United States
| | - Fatih Kokdere
- Neuromodulation Research Facility, TMS Clinic, Butler Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Quincy M. Beck
- Neuromodulation Research Facility, TMS Clinic, Butler Hospital, Providence, RI, United States
| | - Simona Temereanca
- Department of Neuroscience, Brown University, Providence, RI, United States
| | - Andrew M. Fukuda
- Neuromodulation Research Facility, TMS Clinic, Butler Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, United States
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Transcranial alternating current stimulation rescues motor deficits in a mouse model of Parkinson's disease via the production of glial cell line-derived neurotrophic factor. Brain Stimul 2022; 15:645-653. [DOI: 10.1016/j.brs.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 11/15/2022] Open
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32
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Chang WD, Tsou YA, Chen YY, Hung BL. Cranial Electrotherapy Stimulation to Improve the Physiology and Psychology Response, Response-Ability, and Sleep Efficiency in Athletes with Poor Sleep Quality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041946. [PMID: 35206134 PMCID: PMC8871707 DOI: 10.3390/ijerph19041946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 02/04/2023]
Abstract
Athletes often have poor sleep quality before a competition. Sleep quality can stabilize mood and improve sports performance. The randomized controlled study explored the effects of cranial electrotherapy stimulation (CES) on the physiology, psychology, response-ability, and sleep quality of athletes who had poor sleep quality before a competition. Athletes who had poor sleep quality (Pittsburgh Sleep Quality Scale score > 5) and had a competition in less than 2 months were recruited. The athletes were grouped into the CES group, which received a 2-week CES treatment (n = 20, age = 21.55 ± 2.26 years), and a placebo group (n = 20, age = 21.05 ± 1.46 years), which received a 2-week sham CES treatment. We performed biochemical analysis, a simple reaction time test, choice reaction time tests, the Profile of Mood States, heart rate variability (HRV), and an Actigraphy activity recorder to measure outcomes before and after the interventions. Our results revealed no significant differences in blood urea nitrogen, creatine phosphate, testosterone, cortisol, and saliva pH between and within groups (p > 0.05). Significant decreases in negative mood states (i.e., anger, tension, and depression) and choice reaction time in the CES group were noted (p < 0.05), moreover, the anger, tension, and depression mood decreased from 0.36 ± 0.45 (95% CI = 0.16–0.55), 1.62 ± 0.97 (95% CI = 1.19–2.04), and 1.67 ± 1.06 (95% CI = 1.20–2.13) to 0.11 ± 0.20 (95% CI = 0.02–0.19, p = 0.03), 1.12 ± 0.74 (95% CI = 0.79–1.44, p = 0.04), and 0.81 ± 0.75 (95% CI = 0.48–1.13, p = 0.001), respectively. Additionally, choice reaction time was decreased from 420.85 ± 41.22 ms (95% CI = 402.78–438.91) to 399.90 ± 36.71 ms (95% CI = 383.81–415.98, p = 0.04) and was also noted in the CES group. For HRV, and Actigraphy activity for sleep measure, the low-frequency (LF)/high-frequency (HF) ratios changed from 1.80 ± 1.39 (95% CI = 1.19–2.40) to 1.21 ± 0.73 (95% CI = 0.89–1.53, p = 0.10), and sleep efficiency decreased from 87.94 ± 6.76% (95% CI = 84.97–90.90) to 81.75 ± 9.62% (95% CI = 77.53–85.96, p = 0.02) in the CES group. The change in LF/HF after the trial were found between CES and placebo groups (p < 0.05). Yet, the decrease in sleep efficiency in the placebo group were noted (p < 0.05). However, we found that the regression line for sleep efficiency was decreased less during the study while using CES. The CES intervention could reduce negative emotions, improve choice reaction times, enhance the parasympathetic and sympathetic nerve activity imbalances, and slow sleep efficiency deterioration. Regardless, small effect sizes of the application of CES on psychology response, response-ability, and sleep efficiency were concluded in athletes with poor sleep quality before a competition.
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Affiliation(s)
- Wen-Dien Chang
- Department of Sport Performance, National Taiwan University of Sport, Taichung 404401, Taiwan;
- Correspondence:
| | - Yung-An Tsou
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan;
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung 41354, Taiwan
- School of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Yi-Ying Chen
- Department of Sport Performance, National Taiwan University of Sport, Taichung 404401, Taiwan;
| | - Bao-Lien Hung
- Department of Sports Medicine, China Medical University, Taichung 406040, Taiwan;
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33
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Harvey DY, Hamilton R. Noninvasive brain stimulation to augment language therapy for poststroke aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:241-250. [PMID: 35078601 DOI: 10.1016/b978-0-12-823384-9.00012-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behavioral language treatment approaches represent the standard of care for persons with aphasia (PWA), but the benefits of these treatments are variable. Moreover, due to the logistic and financial limitations on the amount of behavioral therapy available to patients, it is often infeasible for PWA to receive behavioral interventions with the level of frequency, intensity, or duration that would provide significant and lasting benefit, underscoring the need for novel, effective treatment approaches. Noninvasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), have emerged as promising neurally-based tools to enhance language abilities for PWA following stroke. This chapter first provides an overview of the methods and physiologic basis motivating the use of NIBS to enhance aphasia recovery followed by a selective review of the growing evidence of its potential as a novel therapeutic tool. Subsequent sections discuss some of the principles that may prove most useful in guiding and optimizing the effects of NIBS on aphasia recovery, focusing on how the functional state of the brain at the time of stimulation interacts with the behavioral aftereffects of neuromodulation. We conclude with a discussion of current challenges and future directions for NIBS in aphasia treatment.
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Affiliation(s)
- Denise Y Harvey
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Roy Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
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Hadi Z, Umbreen A, Anwar MN, Navid MS. The effects of unilateral transcranial direct current stimulation on unimanual laparoscopic peg-transfer task. Brain Res 2021; 1771:147656. [PMID: 34508672 DOI: 10.1016/j.brainres.2021.147656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Efficient training methods are required for laparoscopic surgical skills training to reduce the time needed for proficiency. Transcranial direct current stimulation (tDCS) is widely used to enhance motor skill acquisition and can be used to supplement the training of laparoscopic surgical skill acquisition. The aim of this study was to investigate the effect of anodal tDCS over the primary motor cortex (M1) on the performance of a unimanual variant of the laparoscopic peg-transfer task. METHODS Fifteen healthy subjects participated in this randomized, double-blinded crossover study involving an anodal tDCS and a sham tDCS intervention separated by 48 h. On each intervention day, subjects performed a unimanual variant of laparoscopic peg-transfer task in three sessions (baseline, tDCS, post-tDCS). The tDCS session consisted of 10 min of offline tDCS followed by 10 min of online tDCS. The scores based on the task completion time and the number of errors in each session were used as a primary outcome measure. A linear mixed-effects model was used for the analysis. RESULTS We found that the scores increased over sessions (p < 0.01). However, we found no effects of stimulation (anodal tDCS vs. sham tDCS) and no interaction of stimulation and sessions. CONCLUSION This study suggests that irrespective of the type of current stimulation (anodal and sham) over M1, there was an improvement in the performance of the unimanual peg-transfer task, implying that there was motor learning over time. The results would be useful in designing efficient training paradigms and further investigating the effects of tDCS on laparoscopic peg-transfer tasks.
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Affiliation(s)
- Zaeem Hadi
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, Islamabad, Pakistan; Brain and Vestibular Group, Neuro-otology Unit, Department of Brain Sciences, Faculty of Medicine, Imperial College London, UK
| | - Aysha Umbreen
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, Islamabad, Pakistan
| | - Muhammad Nabeel Anwar
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, Islamabad, Pakistan
| | - Muhammad Samran Navid
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, Islamabad, Pakistan; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand; Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
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Vasu SO, Kaphzan H. The role of sodium channels in direct current stimulation-axonal perspective. Cell Rep 2021; 37:109832. [PMID: 34644580 DOI: 10.1016/j.celrep.2021.109832] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/24/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
Transcranial neurostimulation methods are utilized as therapies for various neuropsychiatric disorders. Primarily, they entail the delivery of weak subthreshold currents across the brain, which modulate neuronal excitability. However, it is still a puzzle how such weak electrical fields actuate their effects. Previous studies showed that axons are the most sensitive subcellular compartment for direct current stimulation, and maximal polarization is achieved at their terminals. Nonetheless, polarization of axon terminals according to models was predicted to be weak, and the mechanism for substantial axon terminals polarization was obscure. Here, we show that a weak subthreshold electrical field modifies the conductance of voltage-dependent sodium channels in axon terminals, subsequently amplifying their membrane polarization. Moreover, we show that this amplification has substantial effects on synaptic functioning. Finally, we employ analytical modeling to explain how sodium currents modifications enhance axon terminal polarization. These findings relate to the mechanistic aspects of any neurostimulation technique.
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Affiliation(s)
- Sreerag Othayoth Vasu
- Laboratory for Neurobiology of Psychiatric Disorders, Sagol Department of Neurobiology, University of Haifa, 199 Aba Khoushy Avenue, Mt. Carmel, 3498838 Haifa, Israel
| | - Hanoch Kaphzan
- Laboratory for Neurobiology of Psychiatric Disorders, Sagol Department of Neurobiology, University of Haifa, 199 Aba Khoushy Avenue, Mt. Carmel, 3498838 Haifa, Israel.
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Montoro CI, Winterholler C, Terrasa JL, Montoya P. Somatosensory Gating Is Modulated by Anodal Transcranial Direct Current Stimulation. Front Neurosci 2021; 15:651253. [PMID: 34557064 PMCID: PMC8452934 DOI: 10.3389/fnins.2021.651253] [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: 01/09/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Anodal transcranial direct current stimulation (tDCS) of the somatosensory cortex causes cerebral hyperexcitability and a significant enhancement in pain thresholds and tactile spatial acuity. Sensory gating is a brain mechanism to suppress irrelevant incoming inputs, which is elicited by presenting pairs of identical stimuli (S1 and S2) within short time intervals between stimuli (e.g., 500 ms). Objectives/Hypothesis The present study addressed the question of whether tDCS could modulate the brain correlates of this inhibitory mechanism. Methods Forty-one healthy individuals aged 18–26 years participated in the study and were randomly assigned to tDCS (n = 21) or SHAM (n = 20). Somatosensory evoked potentials (SEP) elicited by S1 and S2 pneumatic stimuli (duration of 100 ms, ISI 550 ± 50 ms) and applied to the index finger of the dominant hand were recorded before and after tDCS. Results Before the intervention, the second tactile stimuli significantly attenuated the amplitudes of P50, N100, and the late positive complex (LPC, mean amplitude in the time window 150–350) compared to the first stimuli. This confirmed that sensory gating is a widespread brain inhibitory mechanism that can affect early- and middle-latency components of SEPs. Furthermore, our data revealed that this response attenuation or sensory gating (computed as S1 minus S2) was improved after tDCS for LPC, while no changes were found in participants who received SHAM. Conclusion All these findings suggested that anodal tDCS might modulate brain excitability leading to an enhancement of inhibitory mechanisms elicited in response to repetitive somatosensory stimuli during late stages of information processing.
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Affiliation(s)
- Casandra I Montoro
- Research Institute of Health Sciences (IUNICS), Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Christine Winterholler
- Research Institute of Health Sciences (IUNICS), Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Juan L Terrasa
- Research Institute of Health Sciences (IUNICS), Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Pedro Montoya
- Research Institute of Health Sciences (IUNICS), Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
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Herrera-Melendez AL, Bajbouj M, Aust S. Application of Transcranial Direct Current Stimulation in Psychiatry. Neuropsychobiology 2021; 79:372-383. [PMID: 31340213 DOI: 10.1159/000501227] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a neuromodulation technique, which noninvasively alters cortical excitability via weak polarizing currents between two electrodes placed on the scalp. Since it is comparably easy to handle, cheap to use and relatively well tolerated, tDCS has gained increasing interest in recent years. Based on well-known behavioral effects, a number of clinical studies have been performed in populations including patients with major depressive disorder followed by schizophrenia and substance use disorders, in sum with heterogeneous results with respect to efficacy. Nevertheless, the potential of tDCS must not be underestimated since it could be further improved by systematically investigating the various stimulation parameters to eventually increase clinical efficacy. The present article briefly explains the underlying physiology of tDCS, summarizes typical stimulation protocols and then reviews clinical efficacy for various psychiatric disorders as well as prevalent adverse effects. Future developments include combined and more complex interactions of tDCS with pharmacological or psychotherapeutic interventions. In particular, using computational models to individualize stimulation protocols, considering state dependency and applying closed-loop technologies will pave the way for tDCS-based personalized interventions as well as the development of home treatment settings promoting the role of tDCS as an effective treatment option for patients with mental health problems.
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Affiliation(s)
- Ana-Lucia Herrera-Melendez
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany,
| | - Malek Bajbouj
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sabine Aust
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Sunagawa T, Ueda A, Kurumadani H, Zehry HI, Date S, Ishii Y. Transcranial direct current stimulation reduces ischemia-induced sensory disturbance in the hands of healthy subjects. Muscle Nerve 2021; 64:610-613. [PMID: 34378200 DOI: 10.1002/mus.27394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION/AIMS The treatment of entrapment neuropathies, such as carpal tunnel syndrome or cubital tunnel syndrome, has significant challenges that have yet to be solved. To a large extent, the success of the treatment of peripheral nerve damage is dependent on brain plasticity during the recovery process. Recently, noninvasive brain stimulation procedures, such as transcranial direct current stimulation (tDCS), to modulate brain activity have been developed. This study aimed to determine whether tDCS can improve artificially induced ischemic sensory disturbances in the finger. METHODS Ten right-handed, healthy volunteers, with an average age of 25.5 years, participated in this study. A rubber bandage at the base of the right index finger was used to induce a regional sensory disturbance for 30 minutes. An anodal tDCS was applied over their left M1 area 15 minutes into the session. The current perception threshold (CPT) in the index and little finger pad was evaluated using the PainVision system and used as a measure of the sensory threshold. RESULTS In the index finger, the CPT increased significantly with time, a finding that was absent after tDCS application. DISCUSSION It has been reported that anodal tDCS over M1 primarily modulates the functional connectivity of sensory networks, and our findings demonstrate that it improved ischemia-induced sensory disturbances. Modulating the central nervous system using tDCS represents a potential avenue for treating entrapment neuropathies.
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Affiliation(s)
- Toru Sunagawa
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Ueda
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Kurumadani
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hanan Ibrahim Zehry
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shota Date
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yosuke Ishii
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Hu M, Cheng HJ, Ji F, Chong JSX, Lu Z, Huang W, Ang KK, Phua KS, Chuang KH, Jiang X, Chew E, Guan C, Zhou JH. Brain Functional Changes in Stroke Following Rehabilitation Using Brain-Computer Interface-Assisted Motor Imagery With and Without tDCS: A Pilot Study. Front Hum Neurosci 2021; 15:692304. [PMID: 34335210 PMCID: PMC8322606 DOI: 10.3389/fnhum.2021.692304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Brain-computer interface-assisted motor imagery (MI-BCI) or transcranial direct current stimulation (tDCS) has been proven effective in post-stroke motor function enhancement, yet whether the combination of MI-BCI and tDCS may further benefit the rehabilitation of motor functions remains unknown. This study investigated brain functional activity and connectivity changes after a 2 week MI-BCI and tDCS combined intervention in 19 chronic subcortical stroke patients. Patients were randomized into MI-BCI with tDCS group and MI-BCI only group who underwent 10 sessions of 20 min real or sham tDCS followed by 1 h MI-BCI training with robotic feedback. We derived amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and functional connectivity (FC) from resting-state functional magnetic resonance imaging (fMRI) data pre- and post-intervention. At baseline, stroke patients had lower ALFF in the ipsilesional somatomotor network (SMN), lower ReHo in the contralesional insula, and higher ALFF/Reho in the bilateral posterior default mode network (DMN) compared to age-matched healthy controls. After the intervention, the MI-BCI only group showed increased ALFF in contralesional SMN and decreased ALFF/Reho in the posterior DMN. In contrast, no post-intervention changes were detected in the MI-BCI + tDCS group. Furthermore, higher increases in ALFF/ReHo/FC measures were related to better motor function recovery (measured by the Fugl-Meyer Assessment scores) in the MI-BCI group while the opposite association was detected in the MI-BCI + tDCS group. Taken together, our findings suggest that brain functional re-normalization and network-specific compensation were found in the MI-BCI only group but not in the MI-BCI + tDCS group although both groups gained significant motor function improvement post-intervention with no group difference. MI-BCI and tDCS may exert differential or even opposing impact on brain functional reorganization during post-stroke motor rehabilitation; therefore, the integration of the two strategies requires further refinement to improve efficacy and effectiveness.
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Affiliation(s)
- Mengjiao Hu
- NTU Institute for Health Technologies, Interdisciplinary Graduate Programme, Nanyang Technological University, Singapore, Singapore.,Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hsiao-Ju Cheng
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | - Fang Ji
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joanna Su Xian Chong
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhongkang Lu
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
| | - Weimin Huang
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
| | - Kai Keng Ang
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore.,School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Kok Soon Phua
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
| | - Kai-Hsiang Chuang
- Singapore Bioimaging Consortium, Agency for Science Technology and Research, Singapore, Singapore.,Queensland Brain Institute and Centre for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - Xudong Jiang
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore, Singapore
| | - Effie Chew
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - Cuntai Guan
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Juan Helen Zhou
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore.,Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore, Singapore
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Perinatal stroke: mapping and modulating developmental plasticity. Nat Rev Neurol 2021; 17:415-432. [PMID: 34127850 DOI: 10.1038/s41582-021-00503-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 02/04/2023]
Abstract
Most cases of hemiparetic cerebral palsy are caused by perinatal stroke, resulting in lifelong disability for millions of people. However, our understanding of how the motor system develops following such early unilateral brain injury is increasing. Tools such as neuroimaging and brain stimulation are generating informed maps of the unique motor networks that emerge following perinatal stroke. As a focal injury of defined timing in an otherwise healthy brain, perinatal stroke represents an ideal human model of developmental plasticity. Here, we provide an introduction to perinatal stroke epidemiology and outcomes, before reviewing models of developmental plasticity after perinatal stroke. We then examine existing therapeutic approaches, including constraint, bimanual and other occupational therapies, and their potential synergy with non-invasive neurostimulation. We end by discussing the promise of exciting new therapies, including novel neurostimulation, brain-computer interfaces and robotics, all focused on improving outcomes after perinatal stroke.
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Maidan I, Zifman N, Hausdorff JM, Giladi N, Levy-Lamdan O, Mirelman A. A multimodal approach using TMS and EEG reveals neurophysiological changes in Parkinson's disease. Parkinsonism Relat Disord 2021; 89:28-33. [PMID: 34216938 DOI: 10.1016/j.parkreldis.2021.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Alterations in large scale neural networks leading to neurophysiological changes have been described in Parkinson's disease (PD). The combination of transcranial magnetic stimulation (TMS) and electroencephalography (EEG) has been suggested as a promising tool to identify and quantify neurophysiological mechanisms. The aim of this study was to investigate specific changes in electrical brain activity in response to stimulation of four brain areas in patients with PD. METHODS 21 healthy controls and 32 patients with PD underwent a combined TMS-EEG assessment that included stimulation of four brain areas: left M1, right M1, left dorso-lateral prefrontal cortex (DLPFC), and right DLPFC. Six measures were calculated to characterize the TMS evoked potentials (TEP) using EEG: (1) wave form adherence (WFA), (2) late phase deflection (LPD), (3) early phase deflection (EPD), (4) short-term plasticity (STP), (5) inter-trial adherence, and (6) connectivity between right and left M1 and DLPFC. A Linear mixed-model was used to compare these measures between groups and areas stimulated. RESULTS Patients with PD showed lower WFA (p = 0.052), lower EPD (p = 0.009), lower inter-trial adherence (p < 0.001), and lower connectivity between homologs areas (p = 0.050), compared to healthy controls. LPD and STP measures were not different between the groups. In addition, lower inter-trial adherence correlated with longer disease duration (r = -0.355, p = 0.050). CONCLUSIONS Our findings provide evidence to various alterations in neurophysiological measures in patients with PD. The higher cortical excitability along with increased variability and lower widespread of the evoked potentials in PD can elucidate different aspects related to the pathophysiology of the disease.
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Affiliation(s)
- Inbal Maidan
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel.
| | - Noa Zifman
- QuantalX Neuroscience, 'Beer-Yaacov', Israel
| | - Jeffrey M Hausdorff
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel; Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nir Giladi
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Anat Mirelman
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel
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DeMarco AT, Dvorak E, Lacey E, Stoodley CJ, Turkeltaub PE. An Exploratory Study of Cerebellar Transcranial Direct Current Stimulation in Individuals With Chronic Stroke Aphasia. Cogn Behav Neurol 2021; 34:96-106. [PMID: 34074864 PMCID: PMC8186819 DOI: 10.1097/wnn.0000000000000270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aphasia is a common, debilitating consequence of stroke, and speech therapy is often inadequate to achieve a satisfactory outcome. Neuromodulation techniques have emerged as a potential augmentative treatment for improving aphasia outcomes. Most studies have targeted the cerebrum, but there are theoretical and practical reasons that stimulation over the cerebral hemispheres might not be ideal. On the other hand, the right cerebellum is functionally and anatomically linked to major language areas in the left hemisphere, making it a promising alternative target site for stimulation. OBJECTIVE To provide preliminary effect sizes for the ability of a short course of anodal transcranial direct current stimulation (tDCS) targeted over the right cerebellum to enhance language processing in individuals with chronic poststroke aphasia. METHOD Ten individuals received five sessions of open-label anodal tDCS targeting the right cerebellum. The effects of the tDCS were compared with the effects of sham tDCS on 14 controls from a previous clinical trial. In total, 24 individuals with chronic poststroke aphasia participated in the study. Behavioral testing was conducted before treatment, immediately following treatment, and at the 3-month follow-up. RESULTS Cerebellar tDCS did not significantly enhance language processing measured either immediately following treatment or at the 3-month follow-up. The effect sizes of tDCS over sham treatment were generally nil or small, except for the mean length of utterance on the picture description task, for which medium to large effects were observed. CONCLUSION These results may provide guidance for investigators who are planning larger trials of tDCS for individuals with chronic poststroke aphasia.
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Affiliation(s)
- Andrew T DeMarco
- Departments of Rehabilitation Medicine
- Neurology, Georgetown University, Washington, DC
| | | | - Elizabeth Lacey
- Neurology, Georgetown University, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
| | | | - Peter E Turkeltaub
- Neurology, Georgetown University, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
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Viudes-Sarrion N, Velasco E, Delicado-Miralles M, Lillo-Navarro C. Static magnetic stimulation in the central nervous system: a systematic review. Neurol Sci 2021; 42:1733-1749. [PMID: 33675004 DOI: 10.1007/s10072-021-05156-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 02/26/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVE To systematically review the literature on the use of the transcranial static magnetic stimulation (tSMS) technique in humans and animals, its effects on different areas of the central nervous system (CNS), its influence on neural excitability and on the subject's behavior, and its biological effects and future possibilities. All static magnetic field applications that can be considered to have a physiologically similar effect have been reviewed. METHODS We searched studies using key terms in NCBI PubMed, Scopus, PEDro, SciELO, Cochrane, and links to publications (inception to September 2019). Three reviewers independently selected the studies, extracted data, and assessed the methodological quality of the studies using the recommendations described in the Cochrane Handbook for Systematic Reviews of Interventions, PRISMA guidelines. RESULTS We analyzed 27 studies. The reviewed literature suggests that the use of these magnetic fields has an inhibitory effect on different areas of the CNS, such as motor, somatosensory, and visual cortex, cerebellum, and spinal cord. Regarding subject's behavior, the different effects of tSMS appear to be transient and dependent on the stimulated area, such as loss of visual discrimination or improvement of somatosensory perception. In addition, the technique has some therapeutic utility, specifically in pathologies with cortical hyperexcitability. CONCLUSIONS These results suggest that tSMS may be a promising tool to modulate cerebral excitability in a safe and non-invasive way. Further investigations could give a better explanation of its precise mechanisms of action and applications.
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Affiliation(s)
- Nuria Viudes-Sarrion
- Área de Fisioterapia. Departamento de Patología y Cirugía, Universidad Miguel Hernández, 03550, San Juan de Alicante, Spain
- Instituto de Neurociencias de Alicante (CSIC-Universidad Miguel Hernández), San Juan de Alicante, Spain
| | - Enrique Velasco
- Instituto de Neurociencias de Alicante (CSIC-Universidad Miguel Hernández), San Juan de Alicante, Spain
| | - Miguel Delicado-Miralles
- Instituto de Neurociencias de Alicante (CSIC-Universidad Miguel Hernández), San Juan de Alicante, Spain
| | - Carmen Lillo-Navarro
- Área de Fisioterapia. Departamento de Patología y Cirugía, Universidad Miguel Hernández, 03550, San Juan de Alicante, Spain.
- Instituto de Neurociencias de Alicante (CSIC-Universidad Miguel Hernández), San Juan de Alicante, Spain.
- CEIT Fisioterapia. UMH, San Juan de Alicante, Spain.
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Korai SA, Ranieri F, Di Lazzaro V, Papa M, Cirillo G. Neurobiological After-Effects of Low Intensity Transcranial Electric Stimulation of the Human Nervous System: From Basic Mechanisms to Metaplasticity. Front Neurol 2021; 12:587771. [PMID: 33658972 PMCID: PMC7917202 DOI: 10.3389/fneur.2021.587771] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022] Open
Abstract
Non-invasive low-intensity transcranial electrical stimulation (tES) of the brain is an evolving field that has brought remarkable attention in the past few decades for its ability to directly modulate specific brain functions. Neurobiological after-effects of tES seems to be related to changes in neuronal and synaptic excitability and plasticity, however mechanisms are still far from being elucidated. We aim to review recent results from in vitro and in vivo studies that highlight molecular and cellular mechanisms of transcranial direct (tDCS) and alternating (tACS) current stimulation. Changes in membrane potential and neural synchronization explain the ongoing and short-lasting effects of tES, while changes induced in existing proteins and new protein synthesis is required for long-lasting plastic changes (LTP/LTD). Glial cells, for decades supporting elements, are now considered constitutive part of the synapse and might contribute to the mechanisms of synaptic plasticity. This review brings into focus the neurobiological mechanisms and after-effects of tDCS and tACS from in vitro and in vivo studies, in both animals and humans, highlighting possible pathways for the development of targeted therapeutic applications.
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Affiliation(s)
- Sohaib Ali Korai
- Division of Human Anatomy - Laboratory of Neuronal Networks, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federico Ranieri
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, University Campus Bio-Medico, Rome, Italy
| | - Michele Papa
- Division of Human Anatomy - Laboratory of Neuronal Networks, University of Campania "Luigi Vanvitelli", Naples, Italy.,ISBE Italy, SYSBIO Centre of Systems Biology, Milan, Italy
| | - Giovanni Cirillo
- Division of Human Anatomy - Laboratory of Neuronal Networks, University of Campania "Luigi Vanvitelli", Naples, Italy.,Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Pollok B, Schmitz-Justen C, Krause V. Cathodal Transcranial Direct Current Stimulation (tDCS) Applied to the Left Premotor Cortex Interferes with Explicit Reproduction of a Motor Sequence. Brain Sci 2021; 11:207. [PMID: 33572164 PMCID: PMC7914983 DOI: 10.3390/brainsci11020207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/17/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that allows the modulation of cortical excitability. TDCS effects can outlast the stimulation period presumably due to changes of GABA concentration which play a critical role in use-dependent plasticity. Consequently, tDCS and learning-related synaptic plasticity are assumed to share common mechanisms. Motor sequence learning has been related to activation changes within a cortico-subcortical network and findings from a meta-analysis point towards a core network comprising the cerebellum as well as the primary motor (M1) and the dorsolateral premotor cortex (dPMC). The latter has been particularly related to explicit motor learning by means of brain imaging techniques. We here test whether tDCS applied to the left dPMC affects the acquisition and reproduction of an explicitly learned motor sequence. To this end, 18 healthy volunteers received anodal, cathodal and sham tDCS to the left dPMC and were then trained on a serial reaction time task (SRTT) with their right hand. Immediately after the training and after overnight sleep, reproduction of the learned sequence was tested by means of reaction times as well as explicit recall. Regression analyses suggest that following cathodal tDCS reaction times at the end of the SRTT training-block explained a significant proportion of the number of correctly reported sequence items after overnight sleep. The present data suggest the left premotor cortex as one possible target for the application of non-invasive brain stimulation techniques in explicit motor sequence learning with the right hand.
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Affiliation(s)
- Bettina Pollok
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany; (C.S.-J.); (V.K.)
| | - Claire Schmitz-Justen
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany; (C.S.-J.); (V.K.)
| | - Vanessa Krause
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany; (C.S.-J.); (V.K.)
- Department of Neuropsychology, Mauritius Hospital and Neurorehabilitation Center Meerbusch, 40670 Meerbusch, Germany
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Ranieri F, Mariotto S, Dubbioso R, Di Lazzaro V. Brain Stimulation as a Therapeutic Tool in Amyotrophic Lateral Sclerosis: Current Status and Interaction With Mechanisms of Altered Cortical Excitability. Front Neurol 2021; 11:605335. [PMID: 33613416 PMCID: PMC7892772 DOI: 10.3389/fneur.2020.605335] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022] Open
Abstract
In the last 20 years, several modalities of neuromodulation, mainly based on non-invasive brain stimulation (NIBS) techniques, have been tested as a non-pharmacological therapeutic approach to slow disease progression in amyotrophic lateral sclerosis (ALS). In both sporadic and familial ALS cases, neurophysiological studies point to motor cortical hyperexcitability as a possible priming factor in neurodegeneration, likely related to dysfunction of both excitatory and inhibitory mechanisms. A trans-synaptic anterograde mechanism of excitotoxicity is thus postulated, causing upper and lower motor neuron degeneration. Specifically, motor neuron hyperexcitability and hyperactivity are attributed to intrinsic cell abnormalities related to altered ion homeostasis and to impaired glutamate and gamma aminobutyric acid gamma-aminobutyric acid (GABA) signaling. Several neuropathological mechanisms support excitatory and synaptic dysfunction in ALS; additionally, hyperexcitability seems to drive DNA-binding protein 43-kDA (TDP-43) pathology, through the upregulation of unusual isoforms directly contributing to ASL pathophysiology. Corticospinal excitability can be suppressed or enhanced using NIBS techniques, namely, repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), as well as invasive brain and spinal stimulation. Experimental evidence supports the hypothesis that the after-effects of NIBS are mediated by long-term potentiation (LTP)-/long-term depression (LTD)-like mechanisms of modulation of synaptic activity, with different biological and physiological mechanisms underlying the effects of tDCS and rTMS and, possibly, of different rTMS protocols. This potential has led to several small trials testing different stimulation interventions to antagonize excitotoxicity in ALS. Overall, these studies suggest a possible efficacy of neuromodulation in determining a slight reduction of disease progression, related to the type, duration, and frequency of treatment, but current evidence remains preliminary. Main limitations are the small number and heterogeneity of recruited patients, the limited “dosage” of brain stimulation that can be delivered in the hospital setting, the lack of a sufficient knowledge on the excitatory and inhibitory mechanisms targeted by specific stimulation interventions, and the persistent uncertainty on the key pathophysiological processes leading to motor neuron loss. The present review article provides an update on the state of the art of neuromodulation in ALS and a critical appraisal of the rationale for the application/optimization of brain stimulation interventions, in the light of their interaction with ALS pathophysiological mechanisms.
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Affiliation(s)
- Federico Ranieri
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
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Brunyé TT, Patterson JE, Wooten T, Hussey EK. A Critical Review of Cranial Electrotherapy Stimulation for Neuromodulation in Clinical and Non-clinical Samples. Front Hum Neurosci 2021; 15:625321. [PMID: 33597854 PMCID: PMC7882621 DOI: 10.3389/fnhum.2021.625321] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/07/2021] [Indexed: 01/27/2023] Open
Abstract
Cranial electrotherapy stimulation (CES) is a neuromodulation tool used for treating several clinical disorders, including insomnia, anxiety, and depression. More recently, a limited number of studies have examined CES for altering affect, physiology, and behavior in healthy, non-clinical samples. The physiological, neurochemical, and metabolic mechanisms underlying CES effects are currently unknown. Computational modeling suggests that electrical current administered with CES at the earlobes can reach cortical and subcortical regions at very low intensities associated with subthreshold neuromodulatory effects, and studies using electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) show some effects on alpha band EEG activity, and modulation of the default mode network during CES administration. One theory suggests that CES modulates brain stem (e.g., medulla), limbic (e.g., thalamus, amygdala), and cortical (e.g., prefrontal cortex) regions and increases relative parasympathetic to sympathetic drive in the autonomic nervous system. There is no direct evidence supporting this theory, but one of its assumptions is that CES may induce its effects by stimulating afferent projections of the vagus nerve, which provides parasympathetic signals to the cardiorespiratory and digestive systems. In our critical review of studies using CES in clinical and non-clinical populations, we found severe methodological concerns, including potential conflicts of interest, risk of methodological and analytic biases, issues with sham credibility, lack of blinding, and a severe heterogeneity of CES parameters selected and employed across scientists, laboratories, institutions, and studies. These limitations make it difficult to derive consistent or compelling insights from the extant literature, tempering enthusiasm for CES and its potential to alter nervous system activity or behavior in meaningful or reliable ways. The lack of compelling evidence also motivates well-designed and relatively high-powered experiments to assess how CES might modulate the physiological, affective, and cognitive responses to stress. Establishing reliable empirical links between CES administration and human performance is critical for supporting its prospective use during occupational training, operations, or recovery, ensuring reliability and robustness of effects, characterizing if, when, and in whom such effects might arise, and ensuring that any benefits of CES outweigh the risks of adverse events.
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Affiliation(s)
- Tad T. Brunyé
- U. S. Army Combat Capabilities Development Command Soldier Center, Cognitive Science Team, Natick, MA, United States
- Center for Applied Brain and Cognitive Sciences, Tufts University, Medford, MA, United States
| | - Joseph E. Patterson
- Center for Applied Brain and Cognitive Sciences, Tufts University, Medford, MA, United States
| | - Thomas Wooten
- Department of Psychology, Tufts University, Medford, MA, United States
| | - Erika K. Hussey
- U. S. Army Combat Capabilities Development Command Soldier Center, Cognitive Science Team, Natick, MA, United States
- Center for Applied Brain and Cognitive Sciences, Tufts University, Medford, MA, United States
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The effects of non-invasive brain stimulation on sleep disturbances among different neurological and neuropsychiatric conditions: A systematic review. Sleep Med Rev 2021; 55:101381. [DOI: 10.1016/j.smrv.2020.101381] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/17/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
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Oldrati V, Ferrari E, Butti N, Cattaneo Z, Borgatti R, Urgesi C, Finisguerra A. How social is the cerebellum? Exploring the effects of cerebellar transcranial direct current stimulation on the prediction of social and physical events. Brain Struct Funct 2021; 226:671-684. [DOI: 10.1007/s00429-020-02198-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/16/2020] [Indexed: 12/29/2022]
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Abstract
The pathophysiological mechanisms that underlie the generation and maintenance of tinnitus are being unraveled progressively. Based on this knowledge, a large variety of different neuromodulatory interventions have been developed and are still being designed, adapting to the progressive mechanistic insights in the pathophysiology of tinnitus. rTMS targeting the temporal, temporoparietal, and the frontal cortex has been the mainstay of non-invasive neuromodulation. Yet, the evidence is still unclear, and therefore systematic meta-analyses are needed for drawing conclusions on the effectiveness of rTMS in chronic tinnitus. Different forms of transcranial electrical stimulation (tDCS, tACS, tRNS), applied over the frontal and temporal cortex, have been investigated in tinnitus patients, also without robust evidence for universal efficacy. Cortex and deep brain stimulation with implanted electrodes have shown benefit, yet there is insufficient data to support their routine clinical use. Recently, bimodal stimulation approaches have revealed promising results and it appears that targeting different sensory modalities in temporally combined manners may be more promising than single target approaches.While most neuromodulatory approaches seem promising, further research is required to help translating the scientific outcomes into routine clinical practice.
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