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Sabé M, Hyde J, Cramer C, Eberhard A, Crippa A, Brunoni AR, Aleman A, Kaiser S, Baldwin DS, Garner M, Sentissi O, Fiedorowicz JG, Brandt V, Cortese S, Solmi M. Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Across Mental Disorders: A Systematic Review and Dose-Response Meta-Analysis. JAMA Netw Open 2024; 7:e2412616. [PMID: 38776083 PMCID: PMC11112448 DOI: 10.1001/jamanetworkopen.2024.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/21/2024] [Indexed: 05/25/2024] Open
Abstract
Importance Noninvasive brain stimulation (NIBS) interventions have been shown to be efficacious in several mental disorders, but the optimal dose stimulation parameters for each disorder are unknown. Objective To define NIBS dose stimulation parameters associated with the greatest efficacy in symptom improvement across mental disorders. Data Sources Studies were drawn from an updated (to April 30, 2023) previous systematic review based on a search of PubMed, OVID, and Web of Knowledge. Study Selection Randomized clinical trials were selected that tested transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) for any mental disorder in adults aged 18 years or older. Data Extraction and Synthesis Two authors independently extracted the data. A 1-stage dose-response meta-analysis using a random-effects model was performed. Sensitivity analyses were conducted to test robustness of the findings. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures The main outcome was the near-maximal effective doses of total pulses received for TMS and total current dose in coulombs for tDCS. Results A total of 110 studies with 4820 participants (2659 men [61.4%]; mean [SD] age, 42.3 [8.8] years) were included. The following significant dose-response associations emerged with bell-shaped curves: (1) in schizophrenia, high-frequency (HF) TMS on the left dorsolateral prefrontal cortex (LDLPFC) for negative symptoms (χ2 = 9.35; df = 2; P = .009) and TMS on the left temporoparietal junction for resistant hallucinations (χ2 = 36.52; df = 2; P < .001); (2) in depression, HF-DLPFC TMS (χ2 = 14.49; df = 2; P < .001); (3) in treatment-resistant depression, LDLPFC tDCS (χ2 = 14.56; df = 2; P < .001); and (4) in substance use disorder, LDLPFC tDCS (χ2 = 33.63; df = 2; P < .001). The following significant dose-response associations emerged with plateaued or ascending curves: (1) in depression, low-frequency (LF) TMS on the right DLPFC (RDLPFC) with ascending curve (χ2 = 25.67; df = 2; P = .001); (2) for treatment-resistant depression, LF TMS on the bilateral DLPFC with ascending curve (χ2 = 5.86; df = 2; P = .004); (3) in obsessive-compulsive disorder, LF-RDLPFC TMS with ascending curve (χ2 = 20.65; df = 2; P < .001) and LF TMS on the orbitofrontal cortex with a plateaued curve (χ2 = 15.19; df = 2; P < .001); and (4) in posttraumatic stress disorder, LF-RDLPFC TMS with ascending curve (χ2 = 54.15; df = 2; P < .001). Sensitivity analyses confirmed the main findings. Conclusions and Relevance The study findings suggest that NIBS yields specific outcomes based on dose parameters across various mental disorders and brain regions. Clinicians should consider these dose parameters when prescribing NIBS. Additional research is needed to prospectively validate the findings in randomized, sham-controlled trials and explore how other parameters contribute to the observed dose-response association.
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Affiliation(s)
- Michel Sabé
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, United Kingdom
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Joshua Hyde
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, United Kingdom
| | - Catharina Cramer
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Antonia Eberhard
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - André Russowsky Brunoni
- Departamento e Instituto de Psiquiatria da Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, Brazil
| | - André Aleman
- Department of Biomedical Sciences of Cells and Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
| | - David S. Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, United Kingdom
- University Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Matthew Garner
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ontario, Canada
| | - Othman Sentissi
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jess G. Fiedorowicz
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ontario, Canada
| | - Valerie Brandt
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, United Kingdom
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, United Kingdom
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, United Kingdom
- Hassenfeld Children’s Hospital at New York University Langone, New York University Child Study Center, New York, New York
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, United Kingdom
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
| | - Marco Solmi
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Mental Health, The Ottawa Hospital, Ontario, Canada
- SIENCES Laboratory, Department of Psychiatry, University of Ottawa, Ontario, Canada
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Chmiel J, Malinowska A, Rybakowski F, Leszek J. The Effectiveness of Mindfulness in the Treatment of Methamphetamine Addiction Symptoms: Does Neuroplasticity Play a Role? Brain Sci 2024; 14:320. [PMID: 38671972 PMCID: PMC11047954 DOI: 10.3390/brainsci14040320] [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: 03/09/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Methamphetamine is a highly stimulating psychoactive drug that causes life-threatening addictions and affects millions of people around the world. Its effects on the brain are complex and include disturbances in the neurotransmitter systems and neurotoxicity. There are several known treatment methods, but their effectiveness is moderate. It must be emphasised that no drugs have been approved for treatment. For this reason, there is an urgent need to develop new, effective, and safe treatments for methamphetamine. One of the potential treatments is mindfulness meditation. In recent years, this technique has been researched extensively in the context of many neurological and psychiatric disorders. METHODS This review explores the use of mindfulness in the treatment of methamphetamine addiction. Searches were conducted in the PubMed/Medline, Research Gate, and Cochrane databases. RESULTS Ten studies were identified that used mindfulness-based interventions in the treatment of methamphetamine addiction. The results show that mindfulness is an effective form of reducing hunger, risk of relapses, stress indicators, depression, and aggression, alone or in combination with transcranial direct current stimulation (tDCS). Mindfulness also improved the cognitive function in addicts. The included studies used only behavioural measures. The potential mechanisms of mindfulness in addiction were explained, and it was proposed that it can induce neuroplasticity, alleviating the symptoms of addiction. CONCLUSIONS Evidence from the studies suggest that mindfulness may be an effective treatment option for methamphetamine addiction, used alone or in combination with tDCS. However, further high-quality research is required to establish the role of this treatment option in this field. The use of neuroimaging and neurophysiological measures is fundamental to understand the mechanisms of mindfulness.
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Affiliation(s)
- James Chmiel
- Institute of Neurofeedback and tDCS Poland, 70-393 Szczecin, Poland
| | | | - Filip Rybakowski
- Department and Clinic of Psychiatry, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Jerzy Leszek
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
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Divarco R, Ramasawmy P, Petzke F, Antal A. Stimulated brains and meditative minds: A systematic review on combining low intensity transcranial electrical stimulation and meditation in humans. Int J Clin Health Psychol 2023; 23:100369. [PMID: 36817875 PMCID: PMC9932362 DOI: 10.1016/j.ijchp.2023.100369] [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: 11/14/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023] Open
Abstract
Background Low intensity transcranial electrical stimulation (tES) and meditation are two promising, yet variable, non-pharmacological interventions. Growing research is investigating combined effects of both techniques on one's cognitive, emotional, and physical health. Objective This article reviews the current research that combines tES and meditation interventions in healthy and diseased participants. The review considers the intervention parameters and their effects in a well-organized manner. Method A systematic search for clinical and experimental published studies was conducted in the PubMed, Cochrane, and transcranial direct current stimulation (tDCS) databases using common keywords for tES and for meditation techniques well defined by previous studies. Unpublished ongoing studies were identified with the ClinicalTrials.gov and DRKS.de clinical trial websites. Results 20 published studies and 13 ongoing studies were included for qualitative analysis. 13 published articles studied patients with chronic pain, psychological disorders, cognitive impairment, and movement disorders. Anodal tDCS was the only tES technique while mindfulness meditation was the most common meditation type. Eight studies had a main group effect, with outcome improvement in the active combined intervention. However, most published studies showed improvements after at least one combined intervention with variable effects. Conclusion Pairing anodal tDCS with meditation shows promising improvements of the physical, mental, and emotional aspects of daily life. Further studies are required to confirm the relevance of this combination in the clinic.
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Affiliation(s)
- Rebecca Divarco
- Department of Neurology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, Göttingen 37075, Germany
| | - Perianen Ramasawmy
- Department of Neurology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, Göttingen 37075, Germany
| | - Frank Petzke
- Pain Clinic, Department of Anesthesiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Andrea Antal
- Department of Neurology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, Göttingen 37075, Germany
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Bikson M, Ganho-Ávila A, Datta A, Gillick B, Joensson MG, Kim S, Kim J, Kirton A, Lee K, Marjenin T, Onarheim B, Rehn EM, Sack AT, Unal G. Limited output transcranial electrical stimulation 2023 (LOTES-2023): Updates on engineering principles, regulatory statutes, and industry standards for wellness, over-the-counter, or prescription devices with low risk. Brain Stimul 2023; 16:840-853. [PMID: 37201865 PMCID: PMC10350287 DOI: 10.1016/j.brs.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/20/2023] Open
Abstract
The objective and scope of this Limited Output Transcranial Electrical Stimulation 2023 (LOTES-2023) guidance is to update the previous LOTES-2017 guidance. These documents should therefore be considered together. The LOTES provides a clearly articulated and transparent framework for the design of devices providing limited output (specified low-intensity range) transcranial electrical stimulation for a variety of intended uses. These guidelines can inform trial design and regulatory decisions, but most directly inform manufacturer activities - and hence were presented in LOTES-2017 as "Voluntary industry standard for compliance controlled limited output tES devices". In LOTES-2023 we emphasize that these standards are largely aligned across international standards and national regulations (including those in USA, EU, and South Korea), and so might be better understood as "Industry standards for compliance controlled limited output tES devices". LOTES-2023 is therefore updated to reflect a consensus among emerging international standards, as well as best available scientific evidence. "Warnings" and "Precautions" are updated to align with current biomedical evidence and applications. LOTES standards applied to a constrained device dose range, but within this dose range and for different use-cases, manufacturers are responsible to conduct device-specific risk management.
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Affiliation(s)
- Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States.
| | - Ana Ganho-Ávila
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention-CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Abhishek Datta
- Research and Development, Soterix Medical Inc., Woodbridge, NJ, United States
| | - Bernadette Gillick
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Sungjin Kim
- Ybrain Research Institute, Seongnam-si, Gyeonggi-do, South Korea
| | - Jinuk Kim
- Ybrain Research Institute, Seongnam-si, Gyeonggi-do, South Korea
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kiwon Lee
- Ybrain Research Institute, Seongnam-si, Gyeonggi-do, South Korea
| | | | - Balder Onarheim
- Research and Development, PlatoScience ApS, Copenhagen, Denmark
| | - Erik M Rehn
- Research and Development, Flow Neuroscience, Malmo, Skane Lan, Sweden
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Gozde Unal
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States.
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Gallop L, Westwood SJ, Lewis Y, Campbell IC, Schmidt U. Effects of transcranial direct current stimulation in children and young people with psychiatric disorders: a systematic review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02157-0. [PMID: 36764973 DOI: 10.1007/s00787-023-02157-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/26/2023] [Indexed: 02/12/2023]
Abstract
Transcranial direct current stimulation (tDCS) has demonstrated benefits in adults with various psychiatric disorders, but its clinical utility in children and young people (CYP) remains unclear. This PRISMA systematic review used published and ongoing studies to examine the effects of tDCS on disorder-specific symptoms, mood and neurocognition in CYP with psychiatric disorders. We searched Medline via PubMed, Embase, PsychINFO via OVID, and Clinicaltrials.gov up to December 2022. Eligible studies involved multiple session (i.e., treatment) tDCS in CYP (≤ 25 years old) with psychiatric disorders. Two independent raters assessed the eligibility of studies and extracted data using a custom-built form. Of 33 eligible studies (participant N = 517), the majority (n = 27) reported an improvement in at least one outcome measure of disorder-specific symptoms. Few studies (n = 13) examined tDCS effects on mood and/or neurocognition, but findings were mainly positive. Overall, tDCS was well tolerated with minimal side effects. Of 11 eligible ongoing studies, many are sham-controlled RCTs (n = 9) with better blinding techniques and a larger estimated participant enrolment (M = 79.7; range 15-172) than published studies. Although encouraging, the evidence to date is insufficient to firmly conclude that tDCS can improve clinical symptoms, mood, or cognition in CYP with psychiatric disorders. Ongoing studies appear of improved methodological quality; however, future studies should broaden outcome measures to more comprehensively assess the effects of tDCS and develop dosage guidance (i.e., treatment regimens).
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Affiliation(s)
- Lucy Gallop
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK.
| | - Samuel J Westwood
- Department of Psychology, School of Social Science, University of Westminster, London, W1W 6UW, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AB, UK
| | - Yael Lewis
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
- Hadarim Eating Disorder Unit, Shalvata Mental Health Centre, Hod Hasharon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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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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