Review of individualized current flow modeling studies for transcranial electrical stimulation.

There is substantial intersubject variability of behavioral and neurophysiological responses to transcranial electrical stimulation (tES), which represents one of the most important limitations of tES. Many tES protocols utilize a fixed experimental parameter set disregarding individual anatomical and physiological properties. This one-size-fits-all approach might be one reason for the observed interindividual response variability. Simulation of current flow applying head models based on available anatomical data can help to individualize stimulation parameters and contribute to the understanding of the causes of this response variability. Current flow modeling can be used to retrospectively investigate the characteristics of tES effectivity. Previous studies examined, for example, the impact of skull defects and lesions on the modulation of current flow and demonstrated effective stimulation intensities in different age groups. Furthermore, uncertainty analysis of electrical conductivities in current flow modeling indicated the most influential tissue compartments. Current flow modeling, when used in prospective study planning, can potentially guide stimulation configurations resulting in individually effective tES. Specifically, current flow modeling using individual or matched head models can be employed by clinicians and scientists to, for example, plan dosage in tES protocols for individuals or groups of participants. We review studies that show a relationship between the presence of behavioral/neurophysiological responses and features derived from individualized current flow models. We highlight the potential benefits of individualized current flow modeling.

Head phantoms for bioelectromagnetic applications: a material study.

BACKGROUND: Assessments of source reconstruction procedures in electroencephalography and computations of transcranial electrical stimulation profiles require verification and validation with the help of ground truth configurations as implemented by physical head phantoms. For these phantoms, synthetic materials are needed, which are mechanically and electrochemically stable and possess conductivity values similar to the modeled human head tissues. Three-compartment head models comprise a scalp layer with a conductivity range of 0.137 S/m to 2.1 S/m, a skull layer with conductivity values between 0.066 S/m and 0.00275 S/m, and an intracranial volume with an often-used average conductivity value of 0.33 S/m. To establish a realistically shaped physical head phantom with a well-defined volume conduction configuration, we here characterize the electrical conductivity of synthetic materials for modeling head compartments. We analyzed agarose hydrogel, gypsum, and sodium chloride (NaCl) solution as surrogate materials for scalp, skull, and intracranial volume. We measured the impedance of all materials when immersed in NaCl solution using a four-electrode setup. The measured impedance values were used to calculate the electrical conductivity values of each material. Further, the conductivities in the longitudinal and transverse directions of reed sticks immersed in NaCl solution were measured to test their suitability for mimicking the anisotropic conductivity of white matter tracts. RESULTS: We obtained conductivities of 0.314 S/m, 0.30 S/m, 0.311 S/m (2%, 3%, 4% agarose), 0.0425 S/m and 0.0017 S/m (gypsum with and without NaCl in the compound), and 0.332 S/m (0.17% NaCl solution). These values are within the range of the conductivity values used for EEG and TES modeling. The reed sticks showed anisotropic conductivity with a ratio of 1:2.8. CONCLUSION: We conclude that agarose, gypsum, and NaCl solution can serve as stable representations of the three main conductivity compartments of the head, i.e., scalp, skull, and intracranial volume. An anisotropic conductivity structure such as a fiber track in white matter can be modeled using tailored reed sticks inside a volume conductor.

Novel flexible cap for application of transcranial electrical stimulation: a usability study.

BACKGROUND: Advances in transcranial electrical stimulation (tES) are hampered by the conventional rubber electrodes manually attached to the head with rubber bands. This procedure limits montages to a few electrodes, is error prone with respect to electrode configurations and is burdensome for participants and operators. A newly developed flexible cap with integrated textile stimulation electrodes was compared to the conventional setup of rubber electrodes inserted into sponges fixated by rubber bands, with respect to usability and reliability. Two operators applied both setups to 20 healthy volunteers participating in the study. Electrode position and impedance measures as well as subjective evaluations from participants and operators were obtained throughout the stimulation sessions. RESULTS: Our results demonstrated the superiority of the flexible cap by means of significantly higher electrode configuration reproducibility and a more efficient application. Both, operators and volunteers evaluated the flexible cap as easier to use and more comfortable to wear when compared to the conventional setup. CONCLUSION: In conclusion, the new cap improves existing and opens new application scenarios for tES.

Transcranial direct current stimulation changes resting state functional connectivity: A large-scale brain network modeling study.

Transcranial direct current stimulation (tDCS) is a noninvasive technique for affecting brain dynamics with promising application in the clinical therapy of neurological and psychiatric disorders such as Parkinson's disease, Alzheimer's disease, depression, and schizophrenia. Resting state dynamics increasingly play a role in the assessment of connectivity-based pathologies such as Alzheimer's and schizophrenia. We systematically applied tDCS in a large-scale network model of 74 cerebral areas, investigating the spatiotemporal changes in dynamic states as a function of structural connectivity changes. Structural connectivity was defined by the human connectome. The main findings of this study are fourfold: Firstly, we found a tDCS-induced increase in functional connectivity among cerebral areas and among EEG sensors, where the latter reproduced empirical findings of other researchers. Secondly, the analysis of the network dynamics suggested synchronization to be the main mechanism of the observed effects. Thirdly, we found that tDCS sharpens and shifts the frequency distribution of scalp EEG sensors slightly towards higher frequencies. Fourthly, new dynamic states emerged through interacting areas in the network compared to the dynamics of an isolated area. The findings propose synchronization as a key mechanism underlying the changes in the spatiotemporal pattern formation due to tDCS. Our work supports the notion that noninvasive brain stimulation is able to bias brain dynamics by affecting the competitive interplay of functional subnetworks.

Comparison of three-shell and simplified volume conductor models in magnetoencephalography.

Experimental MEG source imaging studies have typically been carried out with either a spherically symmetric head model or a single-shell boundary-element (BEM) model that is shaped according to the inner skull surface. The concepts and comparisons behind these simplified models have led to misunderstandings regarding the role of skull and scalp in MEG. In this work, we assess the forward-model errors due to different skull/scalp approximations and due to differences and errors in model geometries. We built five anatomical models of a volunteer using a set of T1-weighted MR scans and three common toolboxes. Three of the models represented typical models in experimental MEG, one was manually constructed, and one contained a major segmentation error at the skull base. For these anatomical models, we built forward models using four simplified approaches and a three-shell BEM approach that has been used as reference in previous studies. Our reference model contained in addition the skull fine-structure (spongy bone). We computed signal topographies for cortically constrained sources in the left hemisphere and compared the topographies using relative error and correlation metrics. The results show that the spongy bone has a minimal effect on MEG topographies, and thus the skull approximation of the three-shell model is justified. The three-shell model performed best, followed by the corrected-sphere and single-shell models, whereas the local-spheres and single-sphere models were clearly worse. The three-shell model was the most robust against the introduced segmentation error. In contrast to earlier claims, there was no noteworthy difference in the computation times between the realistically-shaped and sphere-based models, and the manual effort of building a three-shell model and a simplified model is comparable. We thus recommend the realistically-shaped three-shell model for experimental MEG work. In cases where this is not possible, we recommend a realistically-shaped corrected-sphere or single-shell model.

Rain may improve survival from direct lightning strikes to the human head.

There is evidence that humans can survive a direct lightning strike to the head. Our question is: could water (rain) on the skin contribute to an increase in the survival rate? We measure the influence of rain during high-energy direct lightning strikes on a realistic three-compartment human head phantom. We find a lower number of perforations and eroded areas near the lightning strike impact points on the head phantom when rain was applied compared to no rain. Current amplitudes in the brain were lower with rain compared to no rain before a fully formed flashover. We conclude that rain on the scalp potentially contributes to the survival rate of 70-90% due to: (1) lower current exposition in the brain before a fully formed flashover, and (2) reduced mechanical and thermal damage.

Electric field temporal interference stimulation of neurons in vitro.

Electrical stimulation (ES) techniques, such as deep brain and transcranial electrical stimulation, have shown promise in alleviating the symptoms of depression and other neurological disorders in vivo. A new noninvasive ES method called temporal interference stimulation (TIS), possesses great potential as it can be used to steer the stimulation and possibly selectively modulate different brain regions. To study TIS in a controlled environment, we successfully established an in vitro 'TIS on a chip' setup using rat cortical neurons on microelectrode arrays (MEAs) in combination with a current stimulator. We validated the developed TIS system and demonstrated the spatial steerability of the stimulation by direct electric field measurements in the chip setup. We stimulated cultures of rat cortical neurons at 28 days in vitro (DIV) by two-channel stimulation delivering 1) TIS at 653 Hz and 643 Hz, resulting in a 10 Hz frequency envelope, 2) low-frequency stimulation (LFS) at 10 Hz and 3) high-frequency stimulation (HFS) at 653 Hz. Unstimulated cultures were used as control/sham. We observed the differences in the electric field strengths during TIS, HFS, and LFS. Moreover, HFS and LFS had the smallest effects on neuronal activity. Instead, TIS elicited neuronal electrophysiological responses, especially 24 hours after stimulation. Our 'TIS on a chip' approach eludicates the applicability of TIS as a method to modulate neuronal electrophysiological activity. The TIS on a chip approach provides spatially steerable stimuli while mitigating the effects of high stimulus fields near the stimulation electrodes. Thus, the approach opens new avenues for stimulation on a chip applications, allowing the study of neuronal responses to gain insights into the potential clinical applications of TIS in treating various brain disorders.

Why Temporal Inference Stimulation May Fail in the Human Brain: A Pilot Research Study.

Temporal interference stimulation (TIS) aims at targeting deep brain areas during transcranial electrical alternating current stimulation (tACS) by generating interference fields at depth. Although its modulatory effects have been demonstrated in animal and human models and stimulation studies, direct experimental evidence is lacking for its utility in humans (in vivo). Herein, we directly test and compare three different structures: firstly, we perform peripheral nerve and muscle stimulation quantifying muscle twitches as readout, secondly, we stimulate peri-orbitally with phosphene perception as a surrogate marker, and thirdly, we attempt to modulate the mean power of alpha oscillations in the occipital area as measured with electroencephalography (EEG). We found strong evidence for stimulation efficacy on the modulated frequency in the PNS, but we found no evidence for its utility in the CNS. Possible reasons for failing to activate CNS targets could be comparatively higher activation thresholds here or inhibitory stimulation components to the carrier frequency interfering with the effects of the modulated signal.

Cortical current density magnitudes during transcranial direct current stimulation correlate with skull thickness in children, adolescent and young adults.

Transcranial direct current stimulation protocols are often applied with a fixed parameter set to all subjects participating in an interventional study. This might lead to considerable effect variation in inhomogeneous subject groups or when transferring stimulation protocols to different age groups. The aim of this study was to evaluate magnitude differences of the electric current density distribution on the gray matter surface in children, adolescent and adults in correlation with the individual volume conductor geometry. We generated individual six compartment finite element models from structural magnetic resonance images of four children (age: 10.95 a±1.32 a), eight adolescents (age: 15.10 a±1.16 a) and eight young adults (age: 21.62 a±2.45 a). We determined the skull thickness in the models as Euclidean distance between the surface of the cerebrospinal fluid compartment and outer skull boundary. For tDCS simulations, we modeled 5×7cm patch electrodes impressing 1mA current intensity as anode and cathode over the left M1 and the right fronto-polar orbit, respectively. The resulting current density was analyzed on the gray matter surface. Our results demonstrate higher cortical current density magnitudes in children compared to adults for a given tDCS current strength. Above the evaluated cortex, the skull thickness increased with age. In conclusion, we underline the importance of age-dependent and individual models in tDCS simulations.

Ocular direct current stimulation affects retinal ganglion cells.

Ocular current stimulation (oCS) with weak current intensities (a few mA) has shown positive effects on retinal nerve cells, which indicates that neurodegenerative ocular diseases could be treated with current stimulation of the eye. During oCS, a significant polarity-independent reduction in the characteristic P50 amplitude of a pattern-reversal electroretinogram was found, while no current stimulation effect was found for a full field electroretinogram (ffERG). The ffERG data indicated a trend for a polarity-dependent influence during oCS on the photopic negative response (PhNR) wave, which represents the sum activity of the retinal ganglion cells. Therefore, an ffERG with adjusted parameters for the standardized measurement of the PhNR wave was combined with simultaneous oCS to study the potential effects of direct oCS on cumulative ganglion cell activity. Compared with that measured before oCS, the PhNR amplitude in the cathodal group increased significantly during current stimulation, while in the anodal and sham groups, no effect was visible (α = 0.05, pcathodal = 0.006*). Furthermore, repeated-measures ANOVA revealed a significant difference in PhNR amplitude between the anodal and cathodal groups as well as between the cathodal and sham groups (p* ≤ 0.0167, pcathodal - anodal = 0.002*, pcathodal - sham = 0.011*).

Effects of Ocular Direct Current Stimulation on Full Field Electroretinogram.

Studies on weak current stimulation (1-2 mA) examine effects on neuronal cells for the treatment of neurological diseases, like depression. Ocular current stimulation showed positive effects on retinal nerve cells which indicate that neurodegenerative ocular diseases, e.g., glaucoma, can be treated with current stimulation of the eye. However, up to now it remains unclear which exact retinal cells can be influenced. During an ocular direct current stimulation, a significant reduction of the characteristic P50 amplitude of a pattern-reversal electroretinogram (PERG) was found for an anodal and a cathodal stimulation. This current stimulation effect could originate from the modulation of pre-ganglion cell activity or by changes in local ON and OFF responses of ganglion cells. For clarification, we investigate acute direct current stimulation effects on a full field electroretinogram (ERG), which represents the activity of pre-ganglion cells (specifically cones and bipolar cells). The ERG from 15 subjects was evaluated before (ERG 1) and during (ERG 2) an ocular direct current stimulation with 800 µA over 5 min. The current was applied through a ring rubber electrode placed around the eye and a 25 cm2 rubber electrode placed at the ipsilateral temple. For ERG measurements, sintered Ag/AgCl skin-electrodes were positioned on the lower eyelid (active), the earlobe (reference), and the forehead (ground). The volunteers were stimulated in three independent sessions, each with a different current application (randomized order): cathodal polarity, anodal polarity (referred to the electrode around the eye), or sham stimulation. The changes between the two ERG measurements of the characteristic full field ERG amplitudes, a-wave, b-wave, and b'-wave (b-wave measured from zero line) were tested with the Wilcoxon signed-rank test (α = 0.05). Comparing before to during the current stimulation for all applications, the ERG waves showed no effects on amplitudes or latencies. Furthermore, no significant difference between the cathodal, anodal, and sham stimulation could be found by a Friedman test. These results indicate an unlikely contribution of pre-ganglion cells to the previously reported stimulation effect on PERG signals.

Contextual MEG and EEG Source Estimates Using Spatiotemporal LSTM Networks.

Most magneto- and electroencephalography (M/EEG) based source estimation techniques derive their estimates sample wise, independently across time. However, neuronal assemblies are intricately interconnected, constraining the temporal evolution of neural activity that is detected by MEG and EEG; the observed neural currents must thus be highly context dependent. Here, we use a network of Long Short-Term Memory (LSTM) cells where the input is a sequence of past source estimates and the output is a prediction of the following estimate. This prediction is then used to correct the estimate. In this study, we applied this technique on noise-normalized minimum norm estimates (MNE). Because the correction is found by using past activity (context), we call this implementation Contextual MNE (CMNE), although this technique can be used in conjunction with any source estimation method. We test CMNE on simulated epileptiform activity and recorded auditory steady state response (ASSR) data, showing that the CMNE estimates exhibit a higher degree of spatial fidelity than the unfiltered estimates in the tested cases.

The Effects of an Ocular Direct Electrical Stimulation on Pattern-Reversal Electroretinogram.

Studies on transcranial current stimulation have shown that a direct current stimulation of the occipital cortex can influence the amplitude size of a visual evoked potential (VEP). The current direction (cathodal or anodal) determines whether the VEP amplitudes increase or decrease. The aim of this study was to design a new experimental setup that will enable a simultaneous ocular direct current stimulation and electroretinogram (ERG) recording which will broaden our understanding of current stimulation effects on the visual system. Furthermore, we examined whether a direct current stimulation on the eye has a similar effect on an ERG as on a VEP. The pattern-reversal ERG was measured with sintered Ag/AgCl skin-electrodes, positioned on the lower eyelid (active), the earlobe (reference), and the forehead (ground). Direct current was applied through a ring rubber electrode placed around the eye and a 5 cm × 5 cm rubber electrode placed at the ipsilateral temple with a current strength of 500 µA and a duration time of 5 min. Fifty-seven healthy volunteers were divided into three groups depending on the current direction (cathodal, anodal, and sham stimulation, n = 19 each). One ERG measurement (ERG 1) was performed before and another (ERG 2) during the direct current stimulation. The difference between ERG 1 and ERG 2 measurements for the characteristic P50, N95 and N95' (N95 minimum measured from zero line) amplitudes were evaluated by both confidence interval analysis and t-test for related samples (α = 0.05, after Bonferroni correction p ∗ = 0.0055). The P50 amplitude was significantly decreased for ERG 2 measurement in the cathodal and anodal stimulation group (cathodal p = 0.001, anodal p = 0.000). No significant changes could be found in the N95 and N95' amplitudes as well as in the sham-stimulation group. Additionally, the latencies did not undergo any significant changes. In conclusion, the newly designed experimental setup enables simultaneous current stimulation and ERG recording. The current influenced P50 amplitude although not the N95 and N95' amplitudes. Furthermore, the amplitude size decreased for both current directions and did not lead to contrary effects as expected.

Corrigendum: Pulsed Electrical Stimulation of the Human Eye Enhances Retinal Vessel Reaction to Flickering Light.

[This corrects the article DOI: 10.3389/fnhum.2019.00371.].

Vision modulation, plasticity and restoration using non-invasive brain stimulation - An IFCN-sponsored review.

The visual system has one of the most complex structures of all sensory systems and is perhaps the most important sense for everyday life. Its functional organization was extensively studied for decades in animal and humans, for example by correlating circumscribed anatomical lesions in patients with the resulting visual dysfunction. During the past two decades, significant achievements were accomplished in characterizing and modulating visual information processing using non-invasive stimulation techniques of the normal and damaged human eye and brain. Techniques include transcranial magnetic stimulation (TMS) and low intensity electric stimulation using either direct or alternating currents applied transcranially (tDCS or tACS) near or above the visual cortex, or alternating currents applied transorbitally (trACS). In the case of transorbital stimulation of the visual system the electrodes are attached near the eye, to the eyelids (transpalpebral electrical stimulation - TPES) or the cornea (tanscorneal electrical stimulation TcES). Here, we summarize the state-of-the-art of visual system magnetic and electric stimulation as a method to modulate normal vision, induce brain plasticity, and to restore visual functions in patients. We review this field's history, models of current flow paths in the eye and brain, neurophysiological principles (e.g. entrainment and after-effects), the effects on vision in normal subjects and the clinical impact on plasticity and vision restoration in patients with low vision, with a particular focus on "off-line" or "after-effects". With regard to the therapeutic possibilities, ACS was demonstrated to be effective in patients affected by glaucoma and optic neuropathy, while tDCS and random noise stimulation (tRNS) are most promising for the treatment of amblyopia, hemianopia and myopia. In addition, rTMS applied above the occipital area is a promising approach to treat migraine, neglect and hemianopia. Although the response to these treatment options is better than to sham stimulation in double blinded clinical studies, the clinical efficacy is still rather variable and a proportion of patients do not respond. It is therefore imperative to better understand the mechanisms of action to be able to optimize treatment protocols possibly through personalization of brain stimulation protocols. By identifying the current opportunities and challenges in the field, we hope to provide insights to help improve neuromodulation protocols to restore visual function in patients with visual system damage.

Pulsed Electrical Stimulation of the Human Eye Enhances Retinal Vessel Reaction to Flickering Light.

Recent studies indicate therapeutic benefits of electrical stimulation in cases of specific ophthalmic diseases that are associated with dysfunctional ocular microcirculation. This suggests effects of electrical stimulation on vascular functions. In the present study, we investigated the effects of electrical stimulation on retinal vessel reactions using dynamic vessel analysis (DVA). Eighty healthy subjects were randomly assigned to one of three groups receiving electrical stimulation with different current intensities: 400 µA (n = 26); 800 µA (n = 27); 1200 µA (n = 27). The electrode montage for electrical stimulation consisted of a ring-shaped active electrode surrounding one eye and a square return electrode at the occiput. Rectangular, monophasic, positive current pulses were applied at 10 Hz for a duration of 60 s per stimulation period. DVA was used to observe the stimulation-induced reactions of retinal vessel diameters in response to different provocations. In three DVA measurements, three stimulus conditions were investigated: flicker light stimulation (FLS); electrical stimulation (ES); simultaneous electrical and flicker light stimulation (ES+FLS). Retinal vasodilation caused by these stimuli was compared using paired t-test. The subjects receiving electrical stimulation with 800 µA showed significantly increased retinal vasodilation for ES+FLS compared to FLS (p < 0.05). No significant differences in retinal vessel reactions were found between ES+FLS and FLS in the 400 and 1200 µA groups. No retinal vasodilation was observed for ES for all investigated current intensities. The results indicate that positive pulsed electrical stimulation of an adequate intensity enhances the flicker light-induced retinal vasodilation.

Modulation of Adaptive Cognitive Control by Prefrontal High-Definition Transcranial Direct Current Stimulation in Older Adults.

OBJECTIVE: Adaptive cognitive control frequently declines in advanced age. Because high-definition transcranial direct current stimulation (HD-tDCS) of the right dorsolateral prefrontal cortex (DLPFC) improved cognitive control in young adults, we investigated if this montage can also improve cognitive control in older individuals. METHOD: In a double-blind, sham HD-tDCS controlled, cross-over design, 36 older participants received right DLPFC HD-tDCS during a visual flanker task. Conflict adaptation (CA) effects on response time (RT) and error rates (ER) assessed adaptive cognitive control. Biophysical modeling assessed the magnitude and distribution of induced current in older adults. RESULTS: Active HD-tDCS enhanced CA in older adults. However, this positive behavioral effect was limited to CA in ER. Similar to results obtained in healthy young adults, current modeling analysis demonstrated focal current delivery to the DLPFC with sufficient magnitude of the induced current to modulate neural function in older adults. DISCUSSION: This study confirms the effectiveness of HD-tDCS to modulate adaptive cognitive control in advanced age.

Measurement and analysis of partial lightning currents in a head phantom.

Direct lightning strikes to the human head can lead to various effects, ranging from burnings to death. The biological and physical mechanisms of a direct lightning strike in the human head are not well understood. The aim of this paper is to design an experimental setup to measure the spatial and temporal current distribution during a direct lightning strike to physical head phantoms to establish normative values for personal lightning protection equipment design and testing. We created head phantoms made of agarose, replicating the geometric and dielectric properties of scalp, skull, and intracranial volume. The bases of the three compartments were galvanically contacted via copper electrodes to measure the current per compartment. We used pulse generators to apply aperiodic voltage and current signals that modelled lightning components. Our experiments indicated that the scalp compartment was exposed to the current with a fraction of 80-90%. The brain and skull compartments were exposed between 6-13% and 3-6% of the total measured current respectively. In case of a flashover, most of the current (98-99%) flowed through the discharge channel. Unlike previous theoretical estimates and measurements in technical setups, we observed considerably longer times for the flashover to build up. In our experiments, the time to build up a fully formed flashover varied from approximately 30-700 µs. The observed current patterns in cases without and with flashover provided information on regions of possible damage in the human head. Consequently, we identified the phenomenon of a flashover as a potential mechanism for humans to survive a lightning strike. Our measured current distributions and amplitudes formed the base for normative values, which can be used in later experimental investigations regarding the possibilities of individual lightning protection equipment for humans.

Head phantoms for electroencephalography and transcranial electric stimulation: a skull material study.

Physical head phantoms allow the assessment of source reconstruction procedures in electroencephalography and electrical stimulation profiles during transcranial electric stimulation. Volume conduction in the head is strongly influenced by the skull, which represents the main conductivity barrier. Realistic modeling of its characteristics is thus important for phantom development. In the present study, we proposed plastic clay as a material for modeling the skull in phantoms. We analyzed five clay types varying in granularity and fractions of fire clay, each with firing temperatures from 550°C to 950°C. We investigated the conductivity of standardized clay samples when immersed in a 0.9% sodium chloride solution with time-resolved four-point impedance measurements. To test the reusability of the clay model, these measurements were repeated after cleaning the samples by rinsing in deionized water for 5 h. We found time-dependent impedance changes for approximately 5 min after immersion in the solution. Thereafter, the conductivities stabilized between 0.0716 S/m and 0.0224 S/m depending on clay type and firing temperatures. The reproducibility of the measurement results proved the effectiveness of the rinsing procedure. Clay provides formability, is permeable to ions, can be adjusted in conductivity value and is thus suitable for the skull modeling in phantoms.

Novel bifunctional cap for simultaneous electroencephalography and transcranial electrical stimulation.

Neuromodulation induced by transcranial electric stimulation (TES) exhibited promising potential for clinical practice. However, the underlying mechanisms remain subject of research. The combination of TES and electroencephalography (EEG) offers great potential for investigating these mechanisms and brain function in general, especially when performed simultaneously. In conventional applications, the combination of EEG and TES suffers from limitations on the electrode level (gel for electrode-skin interface) and the usability level (preparation time, reproducibility of positioning). To overcome these limitations, we designed a bifunctional cap for simultaneous TES-EEG applications. We used novel electrode materials, namely textile stimulation electrodes and dry EEG electrodes integrated in a flexible textile cap. We verified the functionality of this cap by analysing the effect of TES on visual evoked potentials (VEPs). In accordance with previous reports using standard TES, the amplitude of the N75 component was significantly decreased post-stimulation, indicating the feasibility of using this novel flexible cap for simultaneous TES and EEG. Further, we found a significant reduction of the P100 component only during TES, indicating a different brain modulation effect during and after TES. In conclusion, the novel bifunctional cap offers a novel tool for simultaneous TES-EEG applications in clinical research, therapy monitoring and closed-loop stimulation.