Safety and cognitive effect of frontal DC brain polarization in healthy individuals

Enhancement of phonemic verbal fluency in multilingual young adults by transcranial random noise stimulation

Several studies have analyzed the effects of transcranial direct current stimulation on verbal fluency tasks in non-clinical populations. Nevertheless, the reported effects on verbal fluency are inconsistent. In addition, the effect of other techniques such as transcranial random noise stimulation (tRNS) on verbal fluency enhancement has yet to be studied in healthy multilingual populations. This study aims to explore the effects of tRNS on verbal fluency in healthy multilingual individuals. Fifty healthy multilingual (Spanish, English and Basque) adults were randomly assigned to a tRNS or sham group. Electrodes were placed on the left dorsolateral prefrontal cortex and left inferior frontal gyrus. All participants performed phonemic and semantic verbal fluency tasks before, during (online assessment) and immediately after (offline assessment) stimulation in three different languages. The results showed significantly better performance by participants who received tRNS in the phonemic verbal fluency tasks in Spanish (in the online and offline assessment) and English (in the offline assessment). No differences between conditions were found in Basque nor semantic verbal fluency. These findings suggests that tRNS on the left prefrontal cortex could help improve phonemic, yet not semantic, fluency in healthy multilingual adults.

tDCS of right-hemispheric Wernicke's area homologue affects contextual learning of novel lexicon

Numerous studies have shown robust evidence of the right hemisphere's involvement in the language function, for instance in the processing of intonation, grammar, word meanings, metaphors, etc. However, its role in lexicon acquisition remains obscure. We applied transcranial direct current stimulation (tDCS) over the right-hemispheric homologue of Wernicke's area to assess its putative involvement in the processing of different types of novel semantics. After receiving 15 min of anodal, cathodal, or sham (placebo) tDCS, three groups of healthy participants learnt novel concrete and abstract words in the context of short stories. Learning outcomes were assessed using a battery of tests immediately after this contextual learning session and 24 h later. As a result, an inhibitory effect of cathodal tDCS and a facilitatory effect of anodal tDCS were found for abstract word acquisition only. We also found a significant drop in task performance on the second day of the assessment for both word types in all the stimulation groups, suggesting no significant influence of tDCS on the post-learning consolidation of new memory traces. The results suggest an involvement of Wernicke's right-hemispheric counterpart in initial encoding (but not consolidation) of abstract semantics, which may be explained either by the right hemispheres direct role in processing lexical semantics or by an indirect impact of tDCS on contralateral (left-hemispheric) cortical areas through cross-callosal connections.

Effects of Transcranial Direct Current Stimulation on Cognitive Function in Older Adults with and without Mild Cognitive Impairment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

INTRODUCTION

Noninvasive brain stimulation (NIBS) has shown benefits for cognitive function in older adults. However, the effects of transcranial direct current stimulation (tDCS) on cognitive function in older adults are inconsistent across studies, and the evidence for tDCS has limitations. We aim to explore whether tDCS can improve cognitive function and different cognitive domains (i.e., learning and memory and executive function) in adults aged 65 years and older with and without mild cognitive impairment and to further analyze the influencing factors of tDCS.

METHODS

Five English databases (PubMed, Cochrane Library, EMBASE, Web of Science, the cumulative Index to Nursing and Allied Health Literature [CINAHL]) and four Chinese databases were searched from inception to October 14, 2023. Literature screening, data extraction, and quality assessment were completed independently by two reviewers. All statistical analyses were conducted using RevMan software (version 5.3). Standardized mean difference (SMD) along with a 95% confidence interval (CI) was used to express the effect size of the outcomes, and a random-effect model was also used.

RESULTS

A total of 10 RCTs and 1,761 participants were included in the meta-analysis, and the risk of bias in those studies was relatively low. A significant effect favoring tDCS on immediate postintervention cognitive function (SMD = 0.16, Z = 2.36, p = 0.02) was found. However, the effects on immediate postintervention learning and memory (SMD = 0.20, Z = 2.00, p = 0.05) and executive function (SMD = 0.10, Z = 1.22, p = 0.22), and 1-month postintervention cognitive function (SMD = 0.12, Z = 1.50, p = 0.13), learning and memory (SMD = 0.17, Z = 1.39, p = 0.16), and executive function (SMD = 0.08, Z = 0.67, p = 0.51) were not statistically significant.

CONCLUSION

tDCS can significantly improve the immediate postintervention cognitive function of healthy older adults and MCI elderly individuals. Additional longitudinal extensive sample studies are required to clarify the specific effects of tDCS on different cognitive domains, and the optimal tDCS parameters need to be explored to guide clinical practice.

Good moments to stimulate the brain - A randomized controlled double-blinded study on anodal transcranial direct current stimulation of the ventromedial prefrontal cortex on two different time points in a two-day fear conditioning paradigm

It is assumed that extinction learning is a suitable model for understanding the mechanisms underlying exposure therapy. Furthermore, there is evidence that non-invasive brain stimulation (NIBS) can elevate extinction learning by enhancing frontal brain activity and therefore NIBS can augment symptom reduction during exposure therapy in phobias. But, the underlying processes are still not well established. Open questions arise from NIBS time points and electrode placement, among others. Therefore, we investigated in a 2-day fear conditioning experiment, whether anodal transcranial direct current stimulation (tDCS) of the ventromedial prefrontal cortex (vmPFC) modulates either fear memory consolidation or dampened fear reaction during fear extinction. Sixty-six healthy participants were randomly assigned either to a group that received tDCS after fear acquisition (and before fear memory consolidation), to a group that received tDCS directly before fear extinction, or to a control group that never received active stimulation (sham). Differential skin conductance response (SCR) to CS+ vs. CS- was significantly decreased in both tDCS-groups compared to sham group. Our region of interest, the vmPFC, was stimulated best focally with a lateral anode position and a cathode on the contralateral side. But this comes along with a slightly lateral stimulation of vmPFC depending on whether anode is placed left or right. To avoid unintended effects of stimulated sides the two electrode montages (anode left or right) were mirror-inverted which led to differential effects in SCR and electrocortical (mainly late positive potential [LPP]) data in our exploratory analyses. Results indicated that tDCS-timing is relevant for fear reactions via disturbed fear memory consolidation as well as fear expression, and this depends on whether vmPFC is stimulated with either left- or right-sided anode electrode montage. Electrocortical data can shed more light on the underlying neural correlates and exaggerated LPP seems to be associated with disturbed fear memory consolidation and dampened SCR to CS+ vs. CS-, but solely in the right anode electrode montage. Further open questions addressing where and when to stimulate the prefrontal brain in the course of augmenting fear extinction are raised.

Neural Correlates of Semantic Interference and Phonological Facilitation in Picture Naming: A Systematic Review and Coordinate-Based Meta-analysis

Semantic interference (SI) and phonological facilitation (PF) effects occur when multiple representations are co-activated simultaneously in complex naming paradigms, manipulating the context in which word production is set. Although the behavioral consequences of these psycholinguistic effects are well-known, the involved brain structures are still controversial. This paper aims to provide a systematic review and a coordinate-based meta-analysis of the available functional neuroimaging studies investigating SI and PF in picture naming paradigms. The included studies were fMRI experiments on healthy subjects, employing paradigms in which co-activations of representations were obtained by manipulating the naming context using semantically or phonologically related items. We examined the principal methodological aspects of the included studies, emphasizing the existing commonalities and discrepancies across single investigations. We then performed an exploratory coordinate-based meta-analysis of the reported activation peaks of neural response related to SI and PF. Our results consolidated previous findings regarding the involvement of the left inferior frontal gyrus and the left middle temporal gyrus in SI and brought out the role of bilateral inferior parietal regions in PF.

Effects of transcranial alternating current stimulation on cognitive function in people with multiple sclerosis: A randomized controlled trial

BACKGROUND

Cognitive impairment is a core symptom that profoundly impacts the lives of people with multiple sclerosis (PwMS). Since the existing disease modifying therapies can only stabilize, but not actively treat, cognition in PwMS, there is an unmet need to expand approaches to treat these cognitive symptoms. Transcranial alternating current stimulation (tACS) permits frequency-specific entrainment of neural oscillations intrinsic to cognitive activity. However, the effects of the tACS on cognitive function in PwMS have not yet been assessed. We aimed to evaluate the potential efficacy of applying frontal theta-tACS to improve information processing speed in PwMS.

METHODS

60 PwMS with cognitive complaints were enrolled in a double-blinded, randomized, controlled trial with three stimulation groups: 2 mA, 1 mA, or sham control. A single session of theta-tACS was applied while participants were engaged in a cognitive program which has shown to improve processing speed in PwMS. tACS effects were examined by the Symbol Digit Modalities Test (SDMT). Tolerability, side effects and acceptability were measured.

RESULTS

1 mA groups had a significantly higher SDMT score after stimulation compared to their pre-stimulation score, 2 mA group showed a marginally significant improvement of their SDMT score, while the SDMT score in the sham group did not change. Overall, 49% of the stimulation group participants showed a clinically meaningful SDMT improvement (4+-point increase).

CONCLUSION

tACS is a well-tolerated, non-pharmacological intervention. Based on the positive effects observed in the current study of a single session of tACS applied during cognitive engagement, the effects of repeated tACS on cognitive function in PwMS merit further research.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04466228.

Cognitive control enhancement in attention deficit hyperactivity disorder (ADHD) and neurotypical individuals

Cognitive control, which has been localized to the right inferior frontal gyrus (rIFG) based on functional imaging and brain lesion studies, is impaired in patients with ADHD. The present study aims to investigate whether transcranial direct current stimulation (tDCS) over the rIFG might improve cognitive control in ADHD subjects. We hypothesized poorer performance in a cognitive control task, but not in a control language task, in the ADHD subjects. Crucially, following tDCS, we expected the ADHD group to improve their cognitive control. In a double-blind randomized control trial, 42 participants performed the stop signal task (SST) to index their cognitive control level and the language task. Half of them were randomly assigned to the anodal stimulation condition and half to the sham stimulation. The anodal or sham stimulation was applied over the right IFG. Following the stimulation, the participants reset the two tasks to see whether stimulation improved the (predicted) weaker performance in the ADHD group. Stimulation significantly enhanced cognitive control for both groups, with or without ADHD, in the SST task, but no significant stimulation effects were found for the control task. tDCS seems as a promising tool to improve cognitive control in the general population.

Individual Differences in Response to Transcranial Direct Current Stimulation With Language Therapy in Subacute Stroke

BACKGROUND

Transcranial direct current stimulation (tDCS) can be used to improve post-stroke aphasia. However, given the mixed evidence for its efficacy, individual differences may moderate the relative benefit of this strategy. In planned exploratory subgroup analyses, we examined whether age, education, sex, brain-derived neurotrophic factor status, and baseline performance individually impacted improvement in picture naming between baseline and 1 week after the end of the therapy, then whether the combination of factors that predicted recovery of naming and discourse differed for those who received concurrent tDCS.

OBJECTIVE

Examine whether individual differences influenced the effect of tDCS on language recovery.

METHODS

In this randomized, double-blind, sham-controlled, efficacy study of tDCS combined with language therapy for subacute post-stroke aphasia, patients completed an evaluation including the Philadelphia Naming Test and Cookie Theft picture description, which was analyzed for Content Units (CU) and Syllables/CU. Individual factors were examined using linear models including the interaction between treatment group and subgroup.

RESULTS

Significant interactions were observed between tDCS group and both age and education. The predictors of a positive response to tDCS differed from the predictors of a positive response to language treatment alone. While baseline performance was an important predictor of future performance regardless of treatment group, responses to treatment without tDCS were influenced by age whereas responses to treatment with tDCS were not.

CONCLUSIONS

Age and education influence the efficacy of different treatment strategies. Refinement of treatment selection is important to the overall individualization and optimization of post-stroke patient care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02674490.

Simultaneous fMRI and tDCS for Enhancing Training of Flight Tasks

There is a gap in our understanding of how best to apply transcranial direct-current stimulation (tDCS) to enhance learning in complex, realistic, and multifocus tasks such as aviation. Our goal is to assess the effects of tDCS and feedback training on task performance, brain activity, and connectivity using functional magnetic resonance imaging (fMRI). Experienced glider pilots were recruited to perform a one-day, three-run flight-simulator task involving varying difficulty conditions and a secondary auditory task, mimicking real flight requirements. The stimulation group (versus sham) received 1.5 mA high-definition HD-tDCS to the right dorsolateral prefrontal cortex (DLPFC) for 30 min during the training. Whole-brain fMRI was collected before, during, and after stimulation. Active stimulation improved piloting performance both during and post-training, particularly in novice pilots. The fMRI revealed a number of tDCS-induced effects on brain activation, including an increase in the left cerebellum and bilateral basal ganglia for the most difficult conditions, an increase in DLPFC activation and connectivity to the cerebellum during stimulation, and an inhibition in the secondary task-related auditory cortex and Broca's area. Here, we show that stimulation increases activity and connectivity in flight-related brain areas, particularly in novices, and increases the brain's ability to focus on flying and ignore distractors. These findings can guide applied neurostimulation in real pilot training to enhance skill acquisition and can be applied widely in other complex perceptual-motor real-world tasks.

The role of left temporo-parietal and inferior frontal cortex in comprehending syntactically complex sentences: A brain stimulation study

BACKGROUND AND OBJECTIVES

Syntactic competence relies on a left-lateralized network converging on hubs in inferior-frontal and posterior-temporal cortices. We address the question whether anodal transcranial direct current stimulation (a-tDCS) over these hubs can modulate comprehension of sentences, whose syntactic complexity systematically varied along the factors embedding depths and canonicity. Semantic content and length of the sentences were kept identical and forced choice picture matching was required after the full sentence had been presented.

METHODS

We used a single-blind, within-subject, sham-controlled design, applying a-tDCS targeting left posterior tempo-parietal (TP) and left inferior frontal cortex (FC). Stimulation sites were determined by individual neuro-navigation. 20 participants were included of whom 19 entered the analysis. Results were analysed using (generalized) mixed models. In a pilot-experiment in another group of 20 participants we validated the manipulation of syntactic complexity by the two factors embedding depth and argument-order.

RESULTS

Reaction times increased and accuracy decreased with higher embedding depth and non-canonical argument order in both experiments. Notably a-tDCS over TP enhanced sentence-to-picture matching, while FC-stimulation showed no consistent effect. Moreover, the analysis disclosed a session effect, indicating improvements of task performance especially regarding speed.

CONCLUSIONS

We conclude that the posterior 'hub' of the neuronal network affording syntactic analysis represents a 'bottleneck', likely due to working-memory capacity and the challenges of mapping semantic to syntactic information allowing for role assignment. While this does not challenge the role of left inferior-frontal cortex for syntax processing and novel-grammar learning, the application of highly established syntactic rules during sentence comprehension may be considered optimized, thus not augmentable by a-tDCS in the uncompromised network.

SIGNIFICANCE STATEMENT

Anodal transcranial direct current stimulation (a-tDCS) over left temporo-parietal cortex enhances comprehension of complex sentences in uncompromised young speakers. Since a-tDCS over left frontal cortex did not elicit any change, the 'bottleneck' for the understanding of complex sentences seems to be the posterior, temporo-parietal rather than the anterior inferior-frontal 'hub' of language processing. Regarding the attested role of inferior-frontal cortex in syntax processing, we suggest that its function is optimized in competent young speakers, preventing further enhancement by (facilitatory) tDCS. Results shed light on the functional anatomy of syntax processing during sentence comprehension; moreover, they open perspectives for research in the lesioned language network of people with syntactic deficits due to aphasia.

Challenges and future trends in wearable closed-loop neuromodulation to efficiently treat methamphetamine addiction

Achieving abstinence from drugs is a long journey and can be particularly challenging in the case of methamphetamine, which has a higher relapse rate than other drugs. Therefore, real-time monitoring of patients' physiological conditions before and when cravings arise to reduce the chance of relapse might help to improve clinical outcomes. Conventional treatments, such as behavior therapy and peer support, often cannot provide timely intervention, reducing the efficiency of these therapies. To more effectively treat methamphetamine addiction in real-time, we propose an intelligent closed-loop transcranial magnetic stimulation (TMS) neuromodulation system based on multimodal electroencephalogram-functional near-infrared spectroscopy (EEG-fNIRS) measurements. This review summarizes the essential modules required for a wearable system to treat addiction efficiently. First, the advantages of neuroimaging over conventional techniques such as analysis of sweat, saliva, or urine for addiction detection are discussed. The knowledge to implement wearable, compact, and user-friendly closed-loop systems with EEG and fNIRS are reviewed. The features of EEG and fNIRS signals in patients with methamphetamine use disorder are summarized. EEG biomarkers are categorized into frequency and time domain and topography-related parameters, whereas for fNIRS, hemoglobin concentration variation and functional connectivity of cortices are described. Following this, the applications of two commonly used neuromodulation technologies, transcranial direct current stimulation and TMS, in patients with methamphetamine use disorder are introduced. The challenges of implementing intelligent closed-loop TMS modulation based on multimodal EEG-fNIRS are summarized, followed by a discussion of potential research directions and the promising future of this approach, including potential applications to other substance use disorders.

Treatment efficacy of tDCS and predictors of treatment response in patients with post-traumatic stress disorder

BACKGROUND

Although transcranial direct stimulation (tDCS) has been proposed as an alternative treatment option for various psychiatric disorders, there is inconsistent information regarding the treatment effects of tDCS for patients with post-traumatic stress disorder (PTSD). This study aimed to investigate the tDCS efficacy and identify predictors of treatment response to tDCS in patients with PTSD.

METHOD

Fifty-one patients received 10 sessions of tDCS involving the position of the anode over the F3 area and cathode over the F4 as a condition of 2.0 mA and 20 min duration. Digit span test and 10 questionnaires (Clinician-Administered PTSD Scale (CAPS), Cognitive Emotion Regulation Questionnaire (CERQ), Multidimensional Experiential Avoidance Questionnaire (MEAQ), etc.) were used to measure tDCS effects on PTSD symptoms and identify predictors of response to tDCS.

RESULTS

1) 50.9 % of patients had a significant reduction in the frequency and severity of PTSD symptoms, 2) PTSD-related symptoms such as depression, anxiety, rumination, and quality of life were significantly improved, 3) baseline scores on rumination and digit span test significantly predicted treatment response to tDCS.

LIMITATIONS

This study was open design without a sham control group. Also, the patients' medications were not controlled.

CONCLUSION

This study highlighted the efficacy of frontal tDCS for the treatment of patients with PTSD and identified rumination and digit span as favorable predictive factors for the outcomes of tDCS.

Transcranial Magnetic Stimulation in Disorders of Consciousness: An Update and Perspectives

Disorders of consciousness (DOC) is a state in which consciousness is affected by brain injuries, leading to dysfunction in vigilance, awareness, and behavior. DOC encompasses coma, vegetative state, and minimally conscious state based on neurobehavioral function. Currently, DOC is one of the most common neurological disorders with a rapidly increasing incidence worldwide. Therefore, DOC not only impacts the lives of individuals and their families but is also becoming a serious public health threat. Repetitive transcranial magnetic stimulation (rTMS) can stimulate electrical activity using a pulsed magnetic field in the brain, with great value in the treatment of chronic pain, neurological diseases, and mental illnesses. However, the clinical application of rTMS in patients with DOC is debatable. Herein, we report the recent main findings of the clinical therapeutics of rTMS for DOC, including its efficacy and possible mechanisms. In addition, we discuss the potential key parameters (timing, location, frequency, strength, and secession of rTMS applications) that affect the therapeutic efficiency of rTMS in patients with DOC. This review may help develop clinical guidelines for the therapeutic application of rTMS in DOC.

Repetitive Anodal TDCS to the Frontal Cortex Increases the P300 during Working Memory Processing

Transcranial direct current stimulation (TDCS) is a technique with which neuronal activity, and therefore potentially behavior, is modulated by applying weak electrical currents to the scalp. Application of TDCS to enhance working memory (WM) has shown promising but also contradictory results, and little emphasis has been placed on repeated stimulation protocols, in which effects are expected to be increased. We aimed to characterize potential behavioral and electrophysiological changes induced by TDCS during WM training and evaluate whether repetitive anodal TDCS has a greater modulatory impact on the processes underpinning WM than single-session stimulation. We examined the effects of single-session and repetitive anodal TDCS to the dorsolateral prefrontal cortex (DLPFC), targeting the frontal-parietal network, during a WM task in 20 healthy participants. TDCS had no significant impact on behavioral measures, including reaction time and accuracy. Analyzing the electrophysiological response, the P300 amplitude significantly increased following repetitive anodal TDCS, however, positively correlating with task performance. P300 changes were identified over the parietal cortex, which is known to engage with the frontal cortex during WM processing. These findings support the hypothesis that repetitive anodal TDCS modulates electrophysiological processes underlying WM.

Can brain stimulation enhance cognition in clinical populations? A critical review

Many psychiatric and neurological conditions are associated with cognitive impairment for which there are very limited treatment options. Brain stimulation methodologies show promise as novel therapeutics and have cognitive effects. Electroconvulsive therapy (ECT), known more for its related transient adverse cognitive effects, can produce significant cognitive improvement in the weeks following acute treatment. Transcranial magnetic stimulation (TMS) is increasingly used as a treatment for major depression and has acute cognitive effects. Emerging research from controlled studies suggests that repeated TMS treatments may additionally have cognitive benefit. ECT and TMS treatment cause neurotrophic changes, although whether these are associated with cognitive effects remains unclear. Transcranial electrical stimulation methods including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) are in development as novel treatments for multiple psychiatric conditions. These treatments may also produce cognitive enhancement particularly when stimulation occurs concurrently with a cognitive task. This review summarizes the current clinical evidence for these brain stimulation treatments as therapeutics for enhancing cognition. Acute, or short-lasting, effects as well as longer-term effects from repeated treatments are reviewed, together with potential putative neural mechanisms. Areas of future research are highlighted to assist with optimization of these approaches for enhancing cognition.

Inpatient suicide in psychiatric settings: Evaluation of current prevention measures

The risk of suicide in psychiatric hospitals is 50 times higher than in the general population, despite patient safety being a priority for any hospital. However, to date, due to the complexity of assessing suicide risk, there has been no consensus on the suicide prevention measures that should be in place in hospitals. The aim of this work is: To provide an overview of the progress that has been made in the field of inpatient suicide prevention in recent years; discuss the problems that remain; and suggest potential future developments. As new clinical dimensions (notably anhedonia, psychological pain and hopelessness) develop, they should become new therapeutic targets. Team training (like the Gatekeeper Training Program) and the latest advances in suicide risk assessment (such as the Collaborative Assessment and Management of Suicidality) should be implemented in psychiatric wards. Suicide prevention plans (e.g., ASSIP, SAFE-T, etc.) represent easy-to-administer, low-cost interventions. The Mental Health Environment of Care Checklist has been proven effective to reduce suicide risk at hospitals. Furthermore, the types of psychotherapy recommended to reduce suicide risk are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). There are several pharmacological treatments for suicide risk, such as lithium and clozapine, which have been shown to be effective in the long term, as well as ketamine and esketamine, which are more effective in the short term. Following some encouraging recent results, buprenorphine may also be proposed to patients with a suicide risk. Triple chronotherapy rapidly improves depressive symptoms over 9 weeks. Regarding brain stimulation techniques, rTMS has proven to be effective in alleviating multiple dimensions of suicidality.

Pain reduction in fibromyalgia syndrome through pairing transcranial direct current stimulation and mindfulness meditation: A randomized, double-blinded, sham-controlled pilot clinical trial

Background

This double-blinded, randomized and sham-controlled pilot clinical trial aimed to investigate the preliminary clinical efficacy and feasibility of combining mindfulness meditation (MM) and transcranial direct current stimulation (tDCS) for pain and associated symptoms in patients with fibromyalgia syndrome (FMS).

Methods

Included FMS patients (age: 33 to 70) were randomized to three different groups to receive either ten daily sessions of anodal tDCS over the left primary motor cortex paired with MM for 20 min (active + MM, n = 10), sham tDCS combined with MM (sham + MM, n = 10) or no intervention (NoT, n = 10). Patients in the bimodal therapy groups received a week of training in MM prior to the stimulation. Participants reported pain intensity, the primary outcome, by filling in a pain diary daily throughout the whole study. They were also evaluated for quality of life, pressure pain sensitivity, psychological wellbeing, sleep quality and sleep quantity. Assessments were performed at three time points (baseline, immediately after treatment and one-month follow-up).

Results

Participants in the active + MM group did not exhibit reduced pain intensity following the bimodal therapy compared to controls. Patients in active group demonstrated clinically meaningful and significantly higher quality of life following the therapeutic intervention than other groups. There was no significant difference among groups regarding pressure pain sensitivity, sleep parameters and psychological scales. The combined treatment was well tolerated among participants, with no serious adverse effects.

Conclusion

This study was the first to pair these two effective non-pharmacological therapies for pain management in FMS. In the light of an underpowered sample size, repetitive anodal tDCS combined with MM did not improve pain or FMS-associated symptoms. However, patients in the active + MM group reported higher quality of life than the control groups. Studies with more participants and longer follow-ups are required to confirm our findings.

Clinical trial registration

[www.drks.de], identifier [DRKS00023490].

Cerebral metabolic rate of oxygen (CMRO2) changes measured with simultaneous tDCS-MRI in healthy adults

BACKGROUND

Transcranial direct current stimulation (tDCS) is a safe and well-tolerated noninvasive technique used for cortical excitability modulation. tDCS has been extensively investigated for its clinical applications; however further understanding of its underlying in-vivo physiological mechanisms remains a fundamental focus of current research.

OBJECTIVES

We investigated the simultaneous effects of tDCS on cerebral blood flow (CBF), venous blood oxygenation (Yv) and cerebral metabolic rate of oxygen (CMRO₂) using simultaneous MRI in healthy adults to provide a reference frame for its neurobiological mechanisms.

METHODS

Twenty-three healthy participants (age = 35.6 ± 15.0 years old, 10 males) completed a simultaneous tDCS-MRI session in a 3 T scanner fitted with a 64-channels head coil. A MR-compatible tDCS device was used to acquire CBF, Yv and CMRO₂ at three time points: pre-, during- and post- 15 minutes of 2.0 mA tDCS on left anodal dorsolateral prefrontal cortex.

RESULTS

During tDCS, CBF significantly increased (57.10 ± 8.33 mL/100g/min) from baseline (53.67 ± 7.75 mL/100g/min; p < 0.0001) and remained elevated in post-tDCS (56.79 ± 8.70 mL/100g/min). Venous blood oxygenation levels measured in pre-tDCS (60.71 ± 4.12 %) did not significantly change across the three timepoints. The resulting CMRO₂ significantly increased by 5.9 % during-tDCS (175.68 ± 30.78 µmol/100g/min) compared to pre-tDCS (165.84 ± 25.32 µmol/100g/min; p = 0.0015), maintaining increased levels in post-tDCS (176.86 ± 28.58 µmol/100g/min).

CONCLUSIONS

tDCS has immediate effects on neuronal excitability, as measured by increased cerebral blood supply and oxygen consumption supporting increased neuronal firing. These findings provide a standard range of CBF and CMRO₂ changes due to tDCS in healthy adults that may be incorporated in clinical studies to evaluate its therapeutic potential.

Reduced phonemic fluency in progressive supranuclear palsy is due to dysfunction of dominant BA6

Background

Reduced phonemic fluency is extremely frequent in progressive supranuclear palsy (PSP), but its neural correlate is yet to be defined.

Objective

We explored the hypothesis that poor fluency in PSP might be due to neurodegeneration within a dominant frontal circuit known to be involved in speech fluency, including the opercular area, the superior frontal cortex (BA6), and the frontal aslant tract connecting these two regions.

Methods

We correlated performance on a letter fluency task (F, A, and S, 60 s for each letter) with brain metabolism as measured with Fluoro-deoxy-glucose Positron Emission Tomography, using Statistical Parametric Mapping, in 31 patients with PSP.

Results

Reduced letter fluency was associated with significant hypometabolism at the level of left BA6.

Conclusion

Our finding is the first evidence that in PSP, as in other neurogical disorders, poor self-initiated, effortful verbal retrieval appears to be linked to dysfunction of the dominant opercular-aslant-BA6 circuit.

A systematic examination of the neural correlates of subjective time perception with fMRI and tDCS

The ability to keep track of time is one of the fundamental human behaviours that enhance survival in the wild. It is still an essential skill that enables an individual to function well in modern society. In the present study, we tested the attentional gate model, one of the most common conceptual frameworks in studies of subjective time perception. Its utility has been well established, but it has been criticised for its lack of neurophysiological support; few studies attempted to systematically identify its components and their neural correlates. Previous studies established that the dorsolateral prefrontal cortex (DLPFC) was associated with working memory tasks and a correlation between activity in the cerebellum and the timing of tasks. An fMRI study was conducted to confirm that these two cortical regions were activated during the execution of a new time discrimination task that considers individual variations in subjective time perception. Simulations were conducted to optimize the electrode placement in order to maximize the electric fields of tDCS perturbation to these two areas. According to the attentional gate model, hypotheses about tDCS perturbation to subjective time perception, attention and working memory were formulated and tested. Attention and working memory were measured by the attention network and N-back tasks. There are weak effects to the perceived subjective equivalent and the reaction time in the attention network task, but both are not statistically significant after correction for multiple comparisons. Exploration analyses show a link between attention and subjective time perception after tDCS perturbation. To conclude, the results do not support the attentional gate model, but show a linkage between attention and subjective time perception in terms of similar neural circuits and their relationships under certain circumstances.

Safety of Special Waveform of Transcranial Electrical Stimulation (TES): In Vivo Assessment

Intermittent theta burst (iTBS) powered by direct current stimulation (DCS) can safely be applied transcranially to induce neuroplasticity in the human and animal brain cortex. tDCS-iTBS is a special waveform that is used by very few studies, and its safety needs to be confirmed. Therefore, we aimed to evaluate the safety of tDCS-iTBS in an animal model after brain stimulations for 1 h and 4 weeks. Thirty-one Sprague Dawley rats were divided into two groups: (1) short-term stimulation for 1 h/session (sham, low, and high) and (2) long-term for 30 min, 3 sessions/week for 4 weeks (sham and high). The anodal stimulation applied over the primary motor cortex ranged from 2.5 to 4.5 mA/cm². The brain biomarkers and scalp tissues were assessed using ELISA and histological analysis (H&E staining) after stimulations. The caspase-3 activity, cortical myelin basic protein (MBP) expression, and cortical interleukin (IL-6) levels increased slightly in both groups compared to sham. The serum MBP, cortical neuron-specific enolase (NSE), and serum IL-6 slightly changed from sham after stimulations. There was no obvious edema or cell necrosis seen in cortical histology after the intervention. The short- and long-term stimulations did not induce significant adverse effects on brain and scalp tissues upon assessing biomarkers and conducting histological analysis.

10-Hz tACS over the prefrontal cortex improves phonemic fluency in healthy individuals

Verbal fluency is an important indicator of human verbal ability. Methods to improve fluency is an interesting issue necessitating investigation. To do this, the current study required participants to randomly receive transcranial alternating current stimulation (tACS) at 10 Hz, 40 Hz (control frequency), and sham stimulation over the prefrontal cortex before a phonemic fluency task. It was found that 10-Hz tACS significantly improved phonemic fluency relative to sham stimulation. This result demonstrates the modulatory effect of 10-Hz tACS on language ability.

Anodal Transcranial Direct Current Stimulation Over Prefrontal Cortex Slows Sequence Learning in Older Adults

Aging is associated with declines in sensorimotor function. Several studies have demonstrated that transcranial direct current stimulation (tDCS), a form of non-invasive brain stimulation, can be combined with training to mitigate age-related cognitive and motor declines. However, in some cases, the application of tDCS disrupts performance and learning. Here, we applied anodal tDCS either over the left prefrontal cortex (PFC), right PFC, supplementary motor complex (SMC), the left M1, or in a sham condition while older adults (n = 63) practiced a Discrete Sequence Production (DSP), an explicit motor sequence, task across 3 days. We hypothesized that stimulation to either the right or left PFC would enhance motor learning for older adults, based on the extensive literature showing increased prefrontal cortical activity during motor task performance in older adults. Contrary to our predictions, stimulation to the right and left PFC resulted in slowed motor learning, as evidenced by a slower reduction rate of reduction of reaction time and the number of sequence chunks across trials relative to sham in session one and session two, respectively. These findings suggest an integral role of the right PFC early in sequence learning and a role of the left PFC in chunking in older adults, and contribute to mounting evidence of the difficultly of using tDCS in an aging population.

Anodal tDCS over Broca's area improves fast mapping and explicit encoding of novel vocabulary

An accumulating body of evidence suggests that transcranial direct current stimulation (tDCS) can be used to modulate speech processing both in healthy individuals and in patients with speech disorders. There has been, however, no comprehensive study of effects of tDCS of the core language areas in relation to the main word-learning mechanisms. Two principal strategies have been posited as important for natural word acquisition: explicit encoding (EE) which relies on direct instructions and repetition of material, and fast mapping (FM) which operates implicitly, via context-based inference or deduction. We used anodal and cathodal tDCS of Broca's and Wernicke's areas to assess effects of stimulation site and polarity on novel word acquisition in both EE and FM regimes. 160 participants, divided into five groups, received 15 min of cathodal or anodal tDCS over one of the two areas or a sham (placebo) stimulation before learning eight novel words, presented ten times each in a short naturalistic audio-visual word-picture association session, fully counterbalanced across different learning regimes. Behavioural outcome of novel word acquisition was measured immediately after the training in a free recall task, which showed elevated accuracy in all real stimulation groups in comparison with sham stimulation; however, this effect only reached full significance after anodal tDCS of Broca's area. Comparisons between the two learning modes indicated that Broca's anodal tDCS significantly improved both implicit and explicit acquisition of novel vocabulary in comparison with sham tDCS, without, however, any significant differences between EE and FM regimes as such. The results indicate involvement of the left inferior-frontal neocortex in the learning of novel vocabulary and suggest a possibility to promote different types of word acquisition using anodal tDCS of this area.

Reorganization of Brain Functional Connectivity Network and Vision Restoration Following Combined tACS-tDCS Treatment After Occipital Stroke

Objective: Non-invasive brain stimulation (NIBS) is already known to improve visual field functions in patients with optic nerve damage and partially restores the organization of brain functional connectivity networks (FCNs). However, because little is known if NIBS is effective also following brain damage, we now studied the correlation between visual field recovery and FCN reorganization in patients with stroke of the central visual pathway.

Method: In a controlled, exploratory trial, 24 patients with hemianopia were randomly assigned to one of three brain stimulation groups: transcranial direct current stimulation (tDCS)/transcranial alternating current stimulation (tACS) (ACDC); sham tDCS/tACS (AC); sham tDCS/sham tACS (Sham), which were compared to age-matched controls (n = 24). Resting-state electroencephalogram (EEG) was collected at baseline, after 10 days stimulation and at 2 months follow-up. EEG recordings were analyzed for FCN measures using graph theory parameters, and FCN small worldness of the network and long pairwise coherence parameter alterations were then correlated with visual field performance.

Result: ACDC enhanced alpha-band FCN strength in the superior occipital lobe of the lesioned hemisphere at follow-up. A negative correlation (r = −0.80) was found between the intact visual field size and characteristic path length (CPL) after ACDC with a trend of decreased alpha-band centrality of the intact middle occipital cortex. ACDC also significantly decreased delta band coherence between the lesion and the intact occipital lobe, and coherence was enhanced between occipital and temporal lobe of the intact hemisphere in the low beta band. Responders showed significantly higher strength in the low alpha band at follow-up in the intact lingual and calcarine cortex and in the superior occipital region of the lesioned hemisphere.

Conclusion: While ACDC decreases delta band coherence between intact and damaged occipital brain areas indicating inhibition of low-frequency neural oscillations, ACDC increases FCN connectivity between the occipital and temporal lobe in the intact hemisphere. When taken together with the lower global clustering coefficient in responders, these findings suggest that FCN reorganization (here induced by NIBS) is adaptive in stroke. It leads to greater efficiency of neural processing, where the FCN requires fewer connections for visual processing.

The residential stability mindset increases racial in-group bias in empathy

With the deepening of internationalization, the population's mobility has greatly increased, which can impact people's intergroup relationships. The current research examined the hypothesis that residential mobility plays a crucial role in racial in-group bias in empathy (RIBE) with three studies. By manipulating the residential mobility/stability mindset and measuring subjective pain intensity ratings (Study 1) and event-related potentials (ERPs, Study 2) of Chinese adults on painful and neutral expressions of Asian and Caucasian faces, we found that the RIBE in subjective ratings and N1 amplitudes increased and P3 amplitudes decreased in the stability group. Transcranial direct current stimulation (tDCS) manipulation in Study 3 further found that anodal stimulation of the left dorsolateral prefrontal cortex (DLPFC) increased the RIBE of participants with residential stability experience but had no effect on those with residential mobility experience. As residential mobility continues to increase worldwide, we may observe concomitant changes in racial intergroup relationships.

Effects of Transcutaneous Spinal Direct Current Stimulation (tsDCS) in Patients With Chronic Pain: A Clinical and Neurophysiological Study

Background and Aims: Chronic pain is a complex clinical condition, often devastating for patients and unmanageable with pharmacological treatments. Converging evidence suggests that transcutaneous spinal Direct Current Stimulation (tsDCS) might represent a complementary therapy in managing chronic pain. In this randomized, double-blind and sham-controlled crossover study, we assessed tsDCS effects in chronic pain patients.

Methods: Sixteen patients (aged 65.06 ± 16.16 years, eight women) with chronic pain of different etiology underwent sham and anodal tsDCS (anode over the tenth thoracic vertebra, cathode over the somatosensory cortical area: 2.5 mA, 20 min, 5 days for 1 week). As outcomes, we considered the Visual Analog Scale (VAS), the Neuropathic Pain Symptom Inventory (NPSI), and the components of the lower limb flexion reflex (LLFR), i.e., RIII threshold, RII latency and area, RIII latency and area, and flexion reflex (FR) total area. Assessments were conducted before (T0), immediately at the end of the treatment (T1), after 1 week (T2) and 1 month (T3).

Results: Compared to sham, anodal tsDCS reduced RIII area at T2 (p = 0.0043) and T3 (p = 0.0012); similarly, FR total area was reduced at T3 (p = 0.03). Clinically, anodal tsDCS dampened VAS at T3 (p = 0.015), and NPSI scores at T1 (p = 0.0012), and T3 (p = 0.0015), whereas sham condition left them unchanged. Changes in VAS and NPSI scores linearly correlated with the reduction in LLFR areas (p = 0.0004).

Conclusions: Our findings suggest that tsDCS could modulate nociceptive processing and pain perception in chronic pain syndromes.

The effect of transcranial direct stimulation as an add-on treatment to conventional physical therapy on pain intensity and functional ability in individuals with knee osteoarthritis: A randomized controlled trial

OBJECTIVE

To investigate the effect of adding transcranial direct current stimulation (tDCS) to conventional physiotherapy treatment (PT) on pain and performance of individuals with knee osteoarthritis (KOA).

METHODS

Eighty people suffering from chronic KOA participated in this study. They were randomly divided into four treatment groups, including PT combined with tDCS over the primary motor cortex (M1), PT combined with tDCS over the primary sensory cortex (S1), PT combined with tDCS over the dorsolateral prefrontal cortex (DLPFC), and PT combined with sham tDCS. A visual analog scale (VAS) for pain intensity, the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire for knee-related disability, and several performance tests (stepping 15 s, chair stand test in 30 s, and walking 4 × 10 m) were used for assessment following 10 sessions of tDCS (T1), and one month after the last session of tDCS (T2).

RESULTS

Differential effects on pain intensity, knee-related disability, and performance were found between groups. Compared to sham tDCS: (i) tDCS over M1 improved VAS pain score, KOOS disability score, and performance tests at T1 and T2; (ii) tDCS over S1 improved VAS pain score at T1 and T2 and KOOS disability score and performance tests at T2; (iii) tDCS over the DLPFC improved VAS pain score at T1 and performance tests at T1 and T2.

CONCLUSION

tDCS could be a beneficial add-on treatment to conventional PT for pain relief, disability reduction and functional improvement in patients with KOA.

The Effects of Transcranial Direct Current Stimulation Combined with Aerobic Exercise on Pain Thresholds and Electroencephalography in Healthy Adults

OBJECTIVES

We examined whether transcranial direct current stimulation (tDCS) combined with aerobic exercise (AE) modulated the pressure pain threshold (PPT) and peak alpha frequency (PAF) measured via resting electroencephalography.

DESIGN

Single-blind experimental study with a cross-over design.

SETTING

Neuro Rehabilitation Research Center, Kio University.

SUBJECTS

Ten healthy controls participated in this study.

METHODS

Three types of sessions--(i) tDCS, (ii) Sham tDCS/AE, and (iii) tDCS/AE--were tested in this investigation. Anodal stimulation (2 mA, 20 minutes) was applied over the left primary motor cortex. Each session was 20 minutes long. We used the PPT and short-form Profile of Mood States-Brief, as well as PAF measured via resting-electroencephalography, to investigate the effects of tDCS and AE. Heart rate and scores on the Borg scale were used to confirm exercise intensity. PAF was calculated in four regions of interest: frontal, central, parietal, and occipital areas.

RESULTS

The change ratio of PPT increased during each session. The maximum change ratio of PPT were tDCS: 40.7%, Sham tDCS/AE: 51.5%, and tDCS/AE: 83.4%. change ratio of PPT was earlier and higher in the tDCS/AE trials compared with the other sessions. Negative mood was improved after session completion. Significant differences in PAF were found in the occipital area in the Sham tDCS/AE and tDCS/AE sessions.

CONCLUSIONS

The combined tDCS and AE intervention induced significant changes in PPT in a single session, with a PAF that was earlier and higher than those produced during the Sham tDCS/AE and tDCS sessions.

The effect of high-definition transcranial direct current stimulation intensity on motor performance in healthy adults: a randomized controlled trial

Background

The results of transcranial direct current stimulation (tDCS) studies that seek to improve motor performance for people with neurological disorders, by targeting the primary motor cortex, have been inconsistent. One possible reason, among others, for this inconsistency, is that very little is known about the optimal protocols for enhancing motor performance in healthy individuals. The best way to optimize stimulation protocols for enhancing tDCS effects on motor performance by means of current intensity modulation has not yet been determined. We aimed to determine the effect of current intensity on motor performance using–for the first time–a montage optimized for maximal focal stimulation via anodal high-definition tDCS (HD-tDCS) on the right primary motor cortex in healthy subjects.

Methods

Sixty participants randomly received 20-min HD-tDCS at 1.5, 2 mA, or sham stimulation. Participants’ reaching performance with the left hand on a tablet was tested before, during, and immediately following stimulation, and retested after 24 h.

Results

In the current montage of HD-tDCS, movement time did not differ between groups in each timepoint. However, only after HD-tDCS at 1.5 mA did movement time improve at posttest as compared to pretest. This reduction in movement time from pretest to posttest was significantly greater compared to HD-tDCS 2 mA. Following HD-tDCS at 1.5 mA and sham HD-tDCS, but not 2 mA, movement time improved at retest compared to pretest, and at posttest and retest compared to the movement time during stimulation. In HD-tDCS at 2 mA, the negligible reduction in movement time from the course of stimulation to posttest was significantly lower compared to sham HD-tDCS. Across all groups, reaction time improved in retest compared to pretest and to the reaction time during stimulation, and did not differ between groups in each timepoint.

Conclusions

It appears that 2 mA in this particular experimental setup inhibited the learning effects. These results suggest that excitatory effects induced by anodal stimulation do not hold for every stimulation intensity, information that should be taken into consideration when translating tDCS use from the realm of research into more optimal neurorehabilitation.

Trial registration: Clinical Trials Gov, NCT04577768. Registered 6 October 2019 -Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000A9B3&selectaction=Edit&uid=U0005AKF&ts=8&cx=buucf0.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12984-021-00899-z.

Impacts of Transcranial Direct Current Stimulation on the Action Observation Network and Sports Anticipation Task

Effective anticipation skills in sporting cognition have been shown to facilitate expertise in sports. Transcranial direct current stimulation (tDCS) has shown to improve motor and cognitive functioning. Therefore, this study aimed to determine the assistive effects of tDCS on the action observer network in both novice and expert gamers during an occlusion task, as well as the related electroencephalographic spectral power response. Twenty-three novice and 23 expert video gamers received either sham or active tDCS with a right parietal anode and left frontal cathode. Only experts demonstrated a significant improvement in predicting ball direction for the overall and early occlusions after tDCS. Spectral power results revealed significant changes in theta, high-gamma, and delta frequencies. The findings indicate that tDCS was able to modulate anticipatory behavior and cortical activity in experts compared with novice participants, suggesting a facilitatory role for tDCS to improve anticipatory effects and assist as a neurocognitive training technique.

Effects of transcranial direct current stimulation on cognitive dysfunction in multiple sclerosis

BACKGROUND

Around 40%-70% of patients with multiple sclerosis (MS) may experience cognitive impairments during the course of their disease with detrimental effects on social and occupational activities. Transcranial direct current stimulation (tDCS has been investigated in pain, fatigue, and mood disorders related to MS, but to date, few studies have examined effects of tDCS on cognitive performance in MS.

OBJECTIVE

The current study aimed to investigate the effects of a multi-session tDCS protocol on cognitive performance and resting-state brain electrical activities in patients with MS.

METHODS

Twenty-four eligible MS patients were randomly assigned to real (anodal) or sham tDCS groups. Before and after 8 consecutive daily tDCS sessions over the left dorsolateral prefrontal cortex (DLPFC), patients' cognitive performance was assessed using the Cambridge Brain Sciences-Cognitive Platform (CBS-CP). Cortical electrical activity was also evaluated using quantitative electroencephalography (QEEG) analysis at baseline and after the intervention.

RESULTS

Compared to the sham condition, significant improvement in reasoning and executive functions of the patients in the real tDCS group was observed. Attention was also improved considerably but not statistically significantly following real tDCS. However, no significant changes in resting-state brain activities were observed after stimulation in either group.

CONCLUSION

Anodal tDCS over the left DLPFC appears to be a promising therapeutic option for cognitive dysfunction in patients with MS. Larger studies are required to confirm these findings and to investigate underlying neuronal mechanisms.

Modulating short-term auditory memory with focal transcranial direct current stimulation applied to the supramarginal gyrus

Previous studies have shown that transcranial direct current stimulation (tDCS) can affect performance by decreasing regional excitability in a brain region that contributes to the task of interest. To our knowledge, no research to date has found both enhancing and diminishing effects on performance, depending upon which polarity of the current is applied. The supramarginal gyrus (SMG) is an ideal brain region for testing tDCS effects because it is easy to identify using the 10-20 electroencephalography coordinate system, and results of neuroimaging studies have implicated the left SMG in short-term memory for phonological and nonphonological sounds. In the present study, we found that applying tDCS to the left SMG affected pitch memory in a manner that depended upon the polarity of stimulation: cathodal tDCS had a negative impact on performance whereas anodal tDCS had a positive impact. These effects were significantly different from sham stimulation, which did not influence performance; they were also specific to the left hemisphere - no effect was found when applying cathodal stimulation to the right SMG - and were unique to pitch memory as opposed to memory for visual shapes. Our results provide further evidence that the left SMG is a nodal point for short-term auditory storage and demonstrate the potential of tDCS to influence cognitive performance and to causally examine hypotheses derived from neuroimaging studies.

The Role of the Dorsolateral Prefrontal Cortex for Speech and Language Processing

This review article summarizes various functions of the dorsolateral prefrontal cortex (DLPFC) that are related to language processing. To this end, its connectivity with the left-dominant perisylvian language network was considered, as well as its interaction with other functional networks that, directly or indirectly, contribute to language processing. Language-related functions of the DLPFC comprise various aspects of pragmatic processing such as discourse management, integration of prosody, interpretation of nonliteral meanings, inference making, ambiguity resolution, and error repair. Neurophysiologically, the DLPFC seems to be a key region for implementing functional connectivity between the language network and other functional networks, including cortico-cortical as well as subcortical circuits. Considering clinical aspects, damage to the DLPFC causes psychiatric communication deficits rather than typical aphasic language syndromes. Although the number of well-controlled studies on DLPFC language functions is still limited, the DLPFC might be an important target region for the treatment of pragmatic language disorders.

Cognitive Telerehabilitation with Transcranial Direct Current Stimulation Improves Cognitive and Emotional Functioning Following a Traumatic Brain Injury: A Case Study

OBJECTIVE

Cognitive deficits following a traumatic brain injury (TBI) are a leading cause of disability in young adults and there is a critical need for novel approaches to improve cognitive outcomes in TBI survivors. Transcranial direct current stimulation (tDCS) paired with cognitive remediation has emerged as a viable, cost-effective, noninvasive approach for treating cognitive impairments in a wide variety of neurological conditions. Here, we report the first case study utilizing remotely supervised tDCS (RS-tDCS) protocol paired with cognitive remediation in a 29-year-old man with persisting cognitive and emotional sequelae following TBI.

METHOD

Neuropsychological measures were administered before and after the patient completed 20 daily sessions of RS-tDCS (2.0 mA × 20 minutes, left anodal dorsolateral prefrontal cortex montage). During the daily stimulation period, he completed adaptive cognitive training. All treatment procedures were delivered at home and monitored in real time via videoconference with a study technician.

RESULTS

Following 20 RS-tDCS and cognitive training sessions, he had significant improvements (>1 SD) on tests of attention and working memory, semantic fluency, and information processing speed. Mood was also improved.

CONCLUSIONS

This is the first demonstration of at-home telerehabilitation with RS-tDCS and cognitive training to improve cognitive outcomes following TBI.

Phase-IIa randomized, double-blind, sham-controlled, parallel group trial on anodal transcranial direct current stimulation (tDCS) over the left and right tempo-parietal junction in autism spectrum disorder-StimAT: study protocol for a clinical trial

Background

Autism spectrum disorder (ASD) is characterized by impaired social communication and interaction, and stereotyped, repetitive behaviour and sensory interests. To date, there is no effective medication that can improve social communication and interaction in ASD, and effect sizes of behaviour-based psychotherapy remain in the low to medium range. Consequently, there is a clear need for new treatment options. ASD is associated with altered activation and connectivity patterns in brain areas which process social information. Transcranial direct current stimulation (tDCS) is a technique that applies a weak electrical current to the brain in order to modulate neural excitability and alter connectivity. Combined with specific cognitive tasks, it allows to facilitate and consolidate the respective training effects. Therefore, application of tDCS in brain areas relevant to social cognition in combination with a specific cognitive training is a promising treatment approach for ASD.

Methods

A phase-IIa pilot randomized, double-blind, sham-controlled, parallel-group clinical study is presented, which aims at investigating if 10 days of 20-min multi-channel tDCS stimulation of the bilateral tempo-parietal junction (TPJ) at 2.0 mA in combination with a computer-based cognitive training on perspective taking, intention and emotion understanding, can improve social cognitive abilities in children and adolescents with ASD. The main objectives are to describe the change in parent-rated social responsiveness from baseline (within 1 week before first stimulation) to post-intervention (within 7 days after last stimulation) and to monitor safety and tolerability of the intervention. Secondary objectives include the evaluation of change in parent-rated social responsiveness at follow-up (4 weeks after end of intervention), change in other ASD core symptoms and psychopathology, social cognitive abilities and neural functioning post-intervention and at follow-up in order to explore underlying neural and cognitive mechanisms.

Discussion

If shown, positive results regarding change in parent-rated social cognition and favourable safety and tolerability of the intervention will confirm tDCS as a promising treatment for ASD core-symptoms. This may be a first step in establishing a new and cost-efficient intervention for individuals with ASD.

Trial registration

The trial is registered with the German Clinical Trials Register (DRKS), DRKS00014732. Registered on 15 August 2018.

Protocol version

This study protocol refers to protocol version 1.2 from 24 May 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05172-1.

Effects of transcranial direct current stimulation on balance after ischemic stroke (SANDE trial): Study protocol for a multicentric randomized controlled trial

BACKGROUND

Among the tools used for motor rehabilitation after stroke, transcranial direct current electrical stimulation (tDCS) aims to modify cortical excitability and improve motor function. Despite promising results, the effects of tDCS on balance after stroke have not yet been assessed using specific protocols. Therefore, this study will aim to evaluate the effects of tDCS and rehabilitation on balance after stroke.

METHODS

Eighty-two ischemic stroke patients across two inpatient rehabilitation sites in Brazil will be randomized into one of two treatment programs (anodic tDCS and sham tDCS), both associated with balance training, each 2 days/week, for six weeks and monitored for exertion, repetition and quality of movements. The primary outcome measure is the balance. Secondary outcomes will include clinical and functional measures. Outcome data will be assessed at two time points.

DISCUSSION

This trial will contribute to clarify if anodal tDCS is effective when associated with balance training to stroke recovery.

Is value-based choice repetition susceptible to medial frontal transcranial direct current stimulation (tDCS)? A preregistered study

In value-based decision making, people have to weigh different options based on their subjective value. This process, however, also is influenced by choice biases, such as choice repetition: in a series of choices, people are more likely to repeat their decision than to switch to a different choice. Previously, it was shown that transcranial direct current stimulation (tDCS) can affect such choice biases. We applied tDCS over the medial prefrontal cortex to investigate whether tDCS can alter choice repetition in value-based decision making. In a preregistered study, we applied anodal, cathodal, and sham tDCS stimulation to 52 participants. While we found robust choice repetition effects, we did not find support for an effect of tDCS stimulation. We discuss these findings within the larger scope of the tDCS literature and highlight the potential roles of interindividual variability and current density strength.

The effect of combined transcranial pulsed current stimulation and transcutaneous electrical nerve stimulation on lower limb spasticity in children with spastic cerebral palsy: a randomized and controlled clinical study

BACKGROUND

In the current study, we applied a combination of non-invasive neuromodulation modalities concurrently with multiple stimulating electrodes. Specifically, we used transcranial pulsed current stimulation (tPCS) and transcutaneous electrical nerve stimulation (TENS) as a novel strategy for improving lower limb spasticity in children with spastic cerebral palsy (SCP) categorized on levels III-V of the Gross Motor Function Classification System (GMFCS) with minimal side effects.

METHODS

Sixty-three SCP children aged 2-12 years, who were classified on levels III-V of the GMFCS were randomly assigned to one of two groups, resulting in 32 children in the experimental group and 31 children in the control group. The experimental group underwent a combination therapy of tPCS (400 Hz, 1 mA cerebello-cerebral stimulation) and TENS (400 Hz, max 10 mA) for 30 min, followed by 30 min of physiotherapy five times per week for 12 weeks. The control group underwent physiotherapy only 30 mins per day five times per week for 12 weeks. In total, all groups underwent 60 treatment sessions. The primary outcome measures were the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS). Evaluations were performed 3 days before and after treatment.

RESULTS

We found a significant improvement in MAS and MTS scores of the lower limbs in the experimental group compared to the control group in the hip adductors (Left: p = 0.002; Right: p = 0.002), hamstrings (Left: p = 0.001; Right: p < 0.001, and gastrocnemius (Left: p = 0.001; Right: p = 0.000). Moreover, MTS scores of R1, R2 and R2-R1 in left and right hip adduction, knee joint, and ankle joint all showed significant improvements (p ≤ 0.05). Analysis of MAS and MTS scores compared to baseline scores showed significant improvements in the experimental group but declines in the control group.

CONCLUSION

These results are among the first to demonstrate that a combination of tPCS and TENS can significantly improve lower limb spasticity in SCP children classified on GMFCS levels III-V with minimal side effects, presenting a novel strategy for addressing spasticity challenges in children with severe SCP.

TRIAL REGISTRATION

ChiCTR.org, ChiCTR1800020283, Registration: 22 December 2018 (URL: http://www.chictr.org.cn/showproj.aspx?proj=33953 ).

Treating lexical retrieval using letter fluency and tDCS in primary progressive aphasia: a single-case study

Background

In early stages, individuals with Primary Progressive Aphasia (PPA) report language symptoms while scoring within norm in formal language tests. Early intervention is important due to the progressive nature of the disease.

Method

We report a single case study of an individual with logopenic variant PPA (lvPPA). We tested whether letter fluency, used as a therapy task, can improve lexical retrieval when combined with tDCS to either the left inferior-frontal gyrus (IFG) or the left inferior parietal lobe (IPL), administered in two separate therapy phases separated by a wash-out period of three months.

Outcomes and results

We observed increases in number of words retrieved during a letter fluency task in trained and untrained letters, when letter fluency therapy (LeFT) was administered with anodal tDCS. When LeFT was combined with left IFG stimulation, words produced in a letter fluency task were lower frequency and higher age of acquisition after treatment, compared to before treatment and there was also an increase in accuracy and response times in an untrained picture-naming task.

Conclusions

The results indicate that letter fluency therapy combined anodal tDCS is effective in improving lexical retrieval, particularly when left IFG stimulation was used. Effects generalize beyond the trained task, albeit slowing down of responses in picture naming. This task may provide a useful clinical intervention strategy for patients with mild anomia, who are not challenged enough by traditional naming therapies.

Neural oscillatory responses to performance monitoring differ between high- and low-impulsive individuals, but are unaffected by TMS

Higher impulsivity may arise from neurophysiological deficits of cognitive control in the prefrontal cortex. Cognitive control can be assessed by time‐frequency decompositions of electrophysiological data. We aimed to clarify neuroelectric mechanisms of performance monitoring in connection with impulsiveness during a modified Eriksen flanker task in high‐ (n = 24) and low‐impulsive subjects (n = 21) and whether these are modulated by double‐blind, sham‐controlled intermittent theta burst stimulation (iTBS). We found a larger error‐specific peri‐response beta power decrease over fronto‐central sites in high‐impulsive compared to low‐impulsive participants, presumably indexing less effective motor execution processes. Lower parieto‐occipital theta intertrial phase coherence (ITPC) preceding correct responses predicted higher reaction time (RT) and higher RT variability, potentially reflecting efficacy of cognitive control or general attention. Single‐trial preresponse theta phase clustering was coupled to RT in correct trials (weighted ITPC), reflecting oscillatory dynamics that predict trial‐specific behavior. iTBS did not modulate behavior or EEG time‐frequency power. Performance monitoring was associated with time‐frequency patterns reflecting cognitive control (parieto‐occipital theta ITPC, theta weighted ITPC) as well as differential action planning/execution processes linked to trait impulsivity (frontal low beta power). Beyond that, results suggest no stimulation effect related to response‐locked time‐frequency dynamics with the current stimulation protocol. Neural oscillatory responses to performance monitoring differ between high‐ and low‐impulsive individuals, but are unaffected by iTBS.

Direct current stimulation enhances neuronal alpha-synuclein degradation in vitro

Despite transcranial Direct Current Stimulation (DCS) is currently proposed as a symptomatic treatment in Parkinson's disease, the intracellular and molecular mechanisms elicited by this technique are still unknown, and its disease-modifying potential unexplored. Aim of this study was to elucidate the on-line and off-line effects of DCS on the expression, aggregation and degradation of alpha-synuclein (asyn) in a human neuroblastoma cell line under basal conditions and in presence of pharmachologically-induced increased asyn levels. Following DCS, gene and protein expression of asyn and its main autophagic catabolic pathways were assessed by real-time PCR and Western blot, extracellular asyn levels by Dot blot. We found that, under standard conditions, DCS increased monomeric and reduced oligomeric asyn forms, with a concomitant down-regulation of both macroautophagy and chaperone-mediated autophagy. Differently, in presence of rotenone-induced increased asyn, DCS efficiently counteracted asyn accumulation, not acting on its gene transcription, but potentiating its degradation. DCS also reduced intracellular and extracellular asyn levels, increased following lysosomal inhibition, independently from autophagic degradation, suggesting that other mechanisms are also involved. Collectively, these findings suggest that DCS exerts on-line and off-line effects on the expression, aggregation and autophagic degradation of asyn, indicating a till unknown neuroprotective role of tDCS.

Past, Present, and Future of Non-invasive Brain Stimulation Approaches to Treat Cognitive Impairment in Neurodegenerative Diseases: Time for a Comprehensive Critical Review

Low birth rates and increasing life expectancy experienced by developed societies have placed an unprecedented pressure on governments and the health system to deal effectively with the human, social and financial burden associated to aging-related diseases. At present, ∼24 million people worldwide suffer from cognitive neurodegenerative diseases, a prevalence that doubles every five years. Pharmacological therapies and cognitive training/rehabilitation have generated temporary hope and, occasionally, proof of mild relief. Nonetheless, these approaches are yet to demonstrate a meaningful therapeutic impact and changes in prognosis. We here review evidence gathered for nearly a decade on non-invasive brain stimulation (NIBS), a less known therapeutic strategy aiming to limit cognitive decline associated with neurodegenerative conditions. Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation, two of the most popular NIBS technologies, use electrical fields generated non-invasively in the brain to long-lastingly enhance the excitability/activity of key brain regions contributing to relevant cognitive processes. The current comprehensive critical review presents proof-of-concept evidence and meaningful cognitive outcomes of NIBS in eight of the most prevalent neurodegenerative pathologies affecting cognition: Alzheimer's Disease, Parkinson's Disease, Dementia with Lewy Bodies, Primary Progressive Aphasias (PPA), behavioral variant of Frontotemporal Dementia, Corticobasal Syndrome, Progressive Supranuclear Palsy, and Posterior Cortical Atrophy. We analyzed a total of 70 internationally published studies: 33 focusing on Alzheimer's disease, 19 on PPA and 18 on the remaining neurodegenerative pathologies. The therapeutic benefit and clinical significance of NIBS remains inconclusive, in particular given the lack of a sufficient number of double-blind placebo-controlled randomized clinical trials using multiday stimulation regimes, the heterogeneity of the protocols, and adequate behavioral and neuroimaging response biomarkers, able to show lasting effects and an impact on prognosis. The field remains promising but, to make further progress, research efforts need to take in account the latest evidence of the anatomical and neurophysiological features underlying cognitive deficits in these patient populations. Moreover, as the development of in vivo biomarkers are ongoing, allowing for an early diagnosis of these neuro-cognitive conditions, one could consider a scenario in which NIBS treatment will be personalized and made part of a cognitive rehabilitation program, or useful as a potential adjunct to drug therapies since the earliest stages of suh diseases. Research should also integrate novel knowledge on the mechanisms and constraints guiding the impact of electrical and magnetic fields on cerebral tissues and brain activity, and incorporate the principles of information-based neurostimulation.

Acquisition of concrete and abstract words is modulated by tDCS of Wernicke's area

Previous behavioural and neuroimaging research suggested distinct cortical systems involved in processing abstract and concrete semantics; however, there is a dearth of causal evidence to support this. To address this, we applied anodal, cathodal, or sham (placebo) tDCS over Wernicke’s area before a session of contextual learning of novel concrete and abstract words (n = 10 each), presented five times in short stories. Learning effects were assessed at lexical and semantic levels immediately after the training and, to attest any consolidation effects of overnight sleep, on the next day. We observed successful learning of all items immediately after the session, with decreased performance in Day 2 assessment. Importantly, the results differed between stimulation conditions and tasks. Whereas the accuracy of semantic judgement for abstract words was significantly lower in the sham and anodal groups on Day 2 vs. Day 1, no significant performance drop was observed in the cathodal group. Similarly, the cathodal group showed no significant overnight performance reduction in the free recall task for either of the stimuli, unlike the other two groups. Furthermore, between-group analysis showed an overall better performance of both tDCS groups over the sham group, particularly expressed for abstract semantics and cathodal stimulation. In sum, the results suggest overlapping but diverging brain mechanisms for concrete and abstract semantics and indicate a larger degree of involvement of core language areas in storing abstract knowledge. Furthermore, they demonstrate a possiblity to improve learning outcomes using neuromodulatory techniques.

Tinnitus and Brain Stimulation

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.

Long-term effects of cerebellar anodal transcranial direct current stimulation (tDCS) on the acquisition and extinction of conditioned eyeblink responses

Cerebellar transcranial direct current stimulation (tDCS) has been reported to enhance the acquisition of conditioned eyeblink responses (CR), a form of associative motor learning. The aim of the present study was to determine possible long-term effects of cerebellar tDCS on the acquisition and extinction of CRs. Delay eyeblink conditioning was performed in 40 young and healthy human participants. On day 1, 100 paired CS (conditioned stimulus)–US (unconditioned stimulus) trials were applied. During the first 50 paired CS–US trials, 20 participants received anodal cerebellar tDCS, and 20 participants received sham stimulation. On days 2, 8 and 29, 50 paired CS–US trials were applied, followed by 30 CS-only extinction trials on day 29. CR acquisition was not significantly different between anodal and sham groups. During extinction, CR incidences were significantly reduced in the anodal group compared to sham, indicating reduced retention. In the anodal group, learning related increase of CR magnitude tended to be reduced, and timing of CRs tended to be delayed. The present data do not confirm previous findings of enhanced acquisition of CRs induced by anodal cerebellar tDCS. Rather, the present findings suggest a detrimental effect of anodal cerebellar tDCS on CR retention and possibly CR performance.

Anodal Occipital Transcranial Direct Current Stimulation Enhances Perceived Visual Size Illusions

Human early visual cortex has long been suggested to play a crucial role in context-dependent visual size perception through either lateral interaction or feedback projections from higher to lower visual areas. We investigated the causal contribution of early visual cortex to context-dependent visual size perception using the technique of transcranial direct current stimulation and two well-known size illusions (i.e., the Ebbinghaus and Ponzo illusions) and further elucidated the underlying mechanism that mediates the effect of transcranial direct current stimulation over early visual cortex. The results showed that the magnitudes of both size illusions were significantly increased by anodal stimulation relative to sham stimulation but left unaltered by cathodal stimulation. Moreover, the anodal effect persisted even when the central target and surrounding inducers of the Ebbinghaus configuration were presented to different eyes, with the effect lasting no more than 15 min. These findings provide compelling evidence that anodal occipital stimulation enhances the perceived visual size illusions, which is possibly mediated by weakening the suppressive function of the feedback connections from higher to lower visual areas. Moreover, the current study provides further support for the causal role of early visual cortex in the neural processing of context-dependent visual size perception.

Does transcranial direct current stimulation affect selective visual attention in children with left-sided infantile hemiplegia? A randomized, controlled pilot study

Objective:

Infantile hemiplegia due to brain injury is associated with poor attention span, which critically affects the learning and acquisition of new skills, especially among children with left-sided infantile hemiplegia (LSIH). This study aimed to improve the selective visual attention (SVA) of children with LSIH through transcranial direct current stimulation (tDCS).

Methods:

A total of 15 children participated in this randomized, double-blinded, pilot study; of them, 10 experienced LSIH, and the remaining 5 were healthy age-matched controls. All the children performed the Computerized Stroop Color-Word Test (CSCWT) at baseline, during the 5th and 10th treatment sessions, and at follow-up. The experimental (n = 5) and control groups (n = 5) received tDCS, while the sham group (n = 5) received placebo tDCS. All three groups received cognitive training on alternate days, for 3 weeks, with the aim to improve SVA.

Results:

Two-way repeated measures analysis of variance (ANOVA) showed a statistically significant change in the mean scores of CSCWT between time points (baseline, 5th and 10th sessions, and follow-up) within-subject factor, group (experimental, sham) between-subject factor and interaction (time points X group) (p < 0.005). Furthermore, a one-way repeated measures ANOVA showed significant differences between time point (p < 0.005) for the experimental and control group but not the sham group.

Conclusion:

These pilot results suggest that future research should be conducted with adequate samples to enable conclusions to be drawn.