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1.
Neuroimage ; 228: 117571, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33412281

RESUMO

Brain oscillations, e.g. measured by electro- or magnetoencephalography (EEG/MEG), are causally linked to brain functions that are fundamental for perception, cognition and learning. Recent advances in neurotechnology provide means to non-invasively target these oscillations using frequency-tuned amplitude-modulated transcranial alternating current stimulation (AM-tACS). However, online adaptation of stimulation parameters to ongoing brain oscillations remains an unsolved problem due to stimulation artifacts that impede such adaptation, particularly at the target frequency. Here, we introduce a real-time compatible artifact rejection algorithm (Stimulation Artifact Source Separation, SASS) that overcomes this limitation. SASS is a spatial filter (linear projection) removing EEG signal components that are maximally different in the presence versus absence of stimulation. This enables the reliable removal of stimulation-specific signal components, while leaving physiological signal components unaffected. For validation of SASS, we evoked brain activity with known phase and amplitude using 10 Hz visual flickers across 7 healthy human volunteers. 64-channel EEG was recorded during and in absence of 10 Hz AM-tACS targeting the visual cortex. Phase differences between AM-tACS and the visual stimuli were randomized, so that steady-state visually evoked potentials (SSVEPs) were phase-locked to the visual stimuli but not to the AM-tACS signal. For validation, distributions of single-trial amplitude and phase of EEG signals recorded during and in absence of AM-tACS were compared for each participant. When no artifact rejection method was applied, AM-tACS stimulation artifacts impeded assessment of single-trial SSVEP amplitude and phase. Using SASS, amplitude and phase of single trials recorded during and in absence of AM-tACS were comparable. These results indicate that SASS can be used to establish adaptive (closed-loop) AM-tACS, a potentially powerful tool to target various brain functions, and to investigate how AM-tACS interacts with electric brain oscillations.


Assuntos
Algoritmos , Artefatos , Encéfalo/fisiologia , Processamento de Sinais Assistido por Computador , Estimulação Transcraniana por Corrente Contínua/métodos , Adulto , Potenciais Evocados Visuais/fisiologia , Feminino , Humanos , Masculino , Adulto Jovem
2.
Nat Commun ; 12(1): 363, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441542

RESUMO

Aberrant neural oscillations hallmark numerous brain disorders. Here, we first report a method to track the phase of neural oscillations in real-time via endpoint-corrected Hilbert transform (ecHT) that mitigates the characteristic Gibbs distortion. We then used ecHT to show that the aberrant neural oscillation that hallmarks essential tremor (ET) syndrome, the most common adult movement disorder, can be transiently suppressed via transcranial electrical stimulation of the cerebellum phase-locked to the tremor. The tremor suppression is sustained shortly after the end of the stimulation and can be phenomenologically predicted. Finally, we use feature-based statistical-learning and neurophysiological-modelling to show that the suppression of ET is mechanistically attributed to a disruption of the temporal coherence of the aberrant oscillations in the olivocerebellar loop, thus establishing its causal role. The suppression of aberrant neural oscillation via phase-locked driven disruption of temporal coherence may in the future represent a powerful neuromodulatory strategy to treat brain disorders.


Assuntos
Encéfalo/fisiopatologia , Cerebelo/fisiopatologia , Estimulação Encefálica Profunda/métodos , Tremor Essencial/terapia , Estimulação Transcraniana por Corrente Contínua/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Tremor Essencial/diagnóstico , Tremor Essencial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Neurológicos , Monitorização Neurofisiológica/métodos
3.
Behav Neurosci ; 134(5): 369-383, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33001679

RESUMO

This study investigated whether the application of high definition transcranial DC stimulation (HD-tDCS) to the dorsolateral prefrontal cortex reduces cue-induced food craving when combined with food-specific inhibitory control training. Using a within-subjects design, participants (N = 55) received both active and sham HD-tDCS across 2 sessions while completing a Go/No-Go task in which foods were either associated with response inhibition or response execution. Food craving was measured pre and post stimulation using a standardized questionnaire as well as desire to eat ratings for foods associated with both response inhibition and response execution in the training task. Results revealed no effect of HD-tDCS on reducing state food craving or desire to eat. Due to the COVID-19 pandemic, we were unable to achieve our maximum preplanned sample size or our minimum desired Bayesian evidence strength across all a priori hypotheses; however 6 of the 7 hypotheses converged with moderate or stronger evidence in favor of the null hypothesis over the alternative hypothesis. We discuss the importance of individual differences and provide recommendations for future studies with an emphasis on the importance of cognitive interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Fissura/fisiologia , Preferências Alimentares/fisiologia , Córtex Pré-Frontal/fisiologia , Adulto , Teorema de Bayes , Estudos Cross-Over , Sinais (Psicologia) , Feminino , Alimentos , Humanos , Masculino , Inquéritos e Questionários , Estimulação Transcraniana por Corrente Contínua/métodos
5.
PLoS Biol ; 18(9): e3000833, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32898188

RESUMO

The phonological deficit in dyslexia is associated with altered low-gamma oscillatory function in left auditory cortex, but a causal relationship between oscillatory function and phonemic processing has never been established. After confirming a deficit at 30 Hz with electroencephalography (EEG), we applied 20 minutes of transcranial alternating current stimulation (tACS) to transiently restore this activity in adults with dyslexia. The intervention significantly improved phonological processing and reading accuracy as measured immediately after tACS. The effect occurred selectively for a 30-Hz stimulation in the dyslexia group. Importantly, we observed that the focal intervention over the left auditory cortex also decreased 30-Hz activity in the right superior temporal cortex, resulting in reinstating a left dominance for the oscillatory response. These findings establish a causal role of neural oscillations in phonological processing and offer solid neurophysiological grounds for a potential correction of low-gamma anomalies and for alleviating the phonological deficit in dyslexia.


Assuntos
Dislexia/terapia , Leitura , Percepção da Fala , Adolescente , Adulto , Córtex Auditivo/fisiopatologia , Córtex Auditivo/efeitos da radiação , Dislexia/fisiopatologia , Eletroencefalografia , Potenciais Evocados Auditivos/fisiologia , Potenciais Evocados Auditivos/efeitos da radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fonética , Percepção da Fala/fisiologia , Percepção da Fala/efeitos da radiação , Estimulação Transcraniana por Corrente Contínua/métodos , Comportamento Verbal/fisiologia , Comportamento Verbal/efeitos da radiação , Adulto Jovem
6.
PLoS One ; 15(9): e0239125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991590

RESUMO

A mesoscale network model is proposed for the development of spike and wave discharges (SWDs) in the cortico-thalamo-cortical (C-T-C) circuit. It is based on experimental findings in two genetic models of childhood absence epilepsy-rats of WAG/Rij and GAERS strains. The model is organized hierarchically into two levels (brain structures and individual neurons) and composed of compartments for representation of somatosensory cortex, reticular and ventroposteriomedial thalamic nuclei. The cortex and the two thalamic compartments contain excitatory and inhibitory connections between four populations of neurons. Two connected subnetworks both including relevant parts of a C-T-C network responsible for SWD generation are modelled: a smaller subnetwork for the focal area in which the SWD generation can take place, and a larger subnetwork for surrounding areas which can be only passively involved into SWDs, but which is mostly responsible for normal brain activity. This assumption allows modeling of both normal and SWD activity as a dynamical system (no noise is necessary), providing reproducibility of results and allowing future analysis by means of theory of dynamical system theories. The model is able to reproduce most time-frequency changes in EEG activity accompanying the transition from normal to epileptiform activity and back. Three different mechanisms of SWD initiation reported previously in experimental studies were successfully reproduced in the model. The model incorporates also a separate mechanism for the maintenance of SWDs based on coupling analysis from experimental data. Finally, the model reproduces the possibility to stop ongoing SWDs with high frequency electrical stimulation, as described in the literature.


Assuntos
Epilepsia Tipo Ausência/fisiopatologia , Modelos Neurológicos , Neurônios/fisiologia , Córtex Somatossensorial/fisiopatologia , Núcleos Talâmicos/fisiopatologia , Animais , Conjuntos de Dados como Assunto , Modelos Animais de Doenças , Eletroencefalografia , Epilepsia Tipo Ausência/genética , Epilepsia Tipo Ausência/terapia , Masculino , Vias Neurais/fisiopatologia , Ratos , Ratos Transgênicos , Córtex Somatossensorial/citologia , Núcleos Talâmicos/citologia , Estimulação Transcraniana por Corrente Contínua/métodos
7.
Ned Tijdschr Geneeskd ; 1642020 06 11.
Artigo em Holandês | MEDLINE | ID: mdl-32608923

RESUMO

There is increasing interest in the use of non-invasive neurostimulation in the treatment of depressive disorder. A recent meta-analysis compared different forms of neurostimulation, and concluded that the effectiveness of different forms of this therapy, for example repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS), was similar to electroconvulsive therapy (ECT). In this comment we discuss these different techniques; we also stress that an unfair comparison has been made between the different forms of neurostimulation. In daily practice, techniques such as ECT, rTMS, and tDCS are used in different patient groups. ECT, in particular, is highly effective in patients suffering from a major depressive disorder with psychotic features, but this patient group has not been sufficiently included in the studies incorporated with a consequent negative bias towards ECT in this meta-analysis.


Assuntos
Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Magnética Transcraniana/métodos , Feminino , Humanos , Masculino , Metanálise como Assunto , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(29): e21263, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702911

RESUMO

BACKGROUND: Vascular cognitive impairment (VCI) refers to all cognitive disorders caused by cerebrovascular disorders. For the treatment, many types of pharmacologic and nonpharmacologic treatments are used but their underlying mechanisms and effects are unclear. Regarding nonpharmacologic treatment, electroacupuncture (EA), transcranial direct current stimulation (tDCS), and computerized cognitive rehabilitation treatment (CCRT) are effective. Here, we report the protocol for a randomized controlled trial of the effect and safety of combination therapy of EA or tDCS and CCRT in patients with VCI. METHODS: This study will be a prospective, outcome assessor-blinded, parallel-arm, randomized controlled clinical trial. Participants with cognitive impairment caused by stroke after 3 months of onset (n = 45) will be randomly assigned to a CCRT, combination therapy with EA and computerized cognitive rehabilitation treatment, or combination therapy with tDCS and computerized cognitive rehabilitation treatment group. All groups will receive treatment 3 times per week for 8 weeks, giving a total of 24 treatments. The CCRT group will perform a training task like shopping, calculating, and others and involving computerized cognitive assessment and brain training system (RehaCom) for 30 minutes. The combination therapy with EA and computerized cognitive rehabilitation treatment group will receive EA using 8 acupuncture points - baekhoe, sinjeong, both sides of pungji, 4 sites of sishencong - and will be applied using an EA stimulator and receive CCRT for 30 minutes at the same time. The combination therapy with tDCS and computerized cognitive rehabilitation treatment group will receive tDCS treatment and receive CCRT for 30 minutes at the same time. The primary outcome will be evaluated using the Lowenstein occupational therapy cognitive assessment, while other scales assessing walking ability, activities of daily living, and quality of life are considered secondary outcome measures. Outcomes will be evaluated before intervention, at the end of intervention 8 weeks after the first intervention, and 4 weeks after completion of the intervention program. DISCUSSION: This study aims to examine the effect and safety of combination therapy with EA or tDCS and CCRT in patients with VCI. This study can be useful in developing new treatment technologies using collaborative research with combined traditional Korean and conventional medicines. TRIAL REGISTRATION: This trial has been registered with cris.nih.go.kr (registration number, KCT 0003644 Registered 01 April 2019, http://cris.nih.go.kr).


Assuntos
Terapia Cognitivo-Comportamental , Demência Vascular/terapia , Eletroacupuntura , Estimulação Transcraniana por Corrente Contínua , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Cognitivo-Comportamental/métodos , Terapia Combinada , Demência Vascular/reabilitação , Eletroacupuntura/efeitos adversos , Eletroacupuntura/métodos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia Assistida por Computador , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Estimulação Transcraniana por Corrente Contínua/métodos , Resultado do Tratamento , Adulto Jovem
9.
PLoS One ; 15(7): e0222688, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706780

RESUMO

We present the results of a study investigating whether there is an effect of Anodal-Transcranial Direct Current Stimulation (A-tDCS) on working memory (WM) performance. The relative effectiveness of A-tDCS on WM is investigated using a 2-back test protocol using two commonly used memory visual stimuli (shapes and letters). In a double-blinded, randomised, crossover, sham-controlled experiment, real A-tDCS and sham A-tDCS were applied separately to the left dorsolateral prefrontal cortex (L-DLPFC) of twenty healthy subjects. There was a minimal interval of one week between sham and real A-tDCS sessions. For the letters based stimulus experiment, 2-back test recall accuracy was measured for a set of English letters (A-L) which were presented individually in a randomised order where each was separated by a blank interval. A similar 2-back protocol was used for the shapes based stimuli experiment where instead of letters, a set of 12 geometric shapes were used. The working memory accuracy scores measured appeared to be significantly affected by memory stimulus type used and by the application of A-tDCS (repeated measures ANOVA p<0.05). A large effect size (d = 0.98) and statistical significance between sham and real A-tDCS WM scores (p = 0.01) was found when shapes were used as a visual testing stimulus, while low (d = 0.38) effect size and insignificant difference (p = 0.15) was found when letters were used. This results are important as they show that recollection different stimuli used in working memory can be affected differently by A-tDCS application. This highlights the importance of considering using multiple methods of WM testing when assessing the effectiveness of A-tDCS.


Assuntos
Memória de Curto Prazo/fisiologia , Estimulação Transcraniana por Corrente Contínua/métodos , Adulto , Estudos Cross-Over , Método Duplo-Cego , Feminino , Voluntários Saudáveis , Humanos , Aprendizagem , Masculino , Córtex Pré-Frontal/fisiologia , Adulto Jovem
10.
Phys Ther ; 100(9): 1595-1602, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32526017

RESUMO

OBJECTIVE: Although some studies have shown the clinical benefits of therapeutic exercise in chronic nonspecific low back pain, the effect sizes are generally small to moderate and recurrence rates are high. Transcranial direct current stimulation (tDCS) has been used to modulate pain-processing systems and motor outputs and has the potential to optimize the clinical benefits of therapeutic exercise. However, evidence for this combination is still lacking. The purpose of this protocol for a randomized clinical trial is to investigate whether the combination of tDCS and therapeutic exercise is more effective in relieving pain than therapeutic exercise alone. METHODS: This 2-arm, randomized controlled clinical trial will take place at the Federal University of Piauí, Brazil. Sixty patients will be randomized into 2 groups to receive tDCS (real/sham) + exercise therapies for 12 sessions over a period of 4 weeks. Pain intensity, sensory and affective aspects of pain, physical functioning, kinesiophobia, and global perceived effect will be recorded before treatment and at 4 weeks, 3 months, and 6 months after randomization. Data will be collected by an examiner unaware of (blind to) the treatment allocation. IMPACT: This trial can potentially provide important information and assist in clinical decision-making on the combined use of tDCS to optimize the clinical benefits of therapeutic exercise in patients with chronic nonspecific low back pain.


Assuntos
Dor Crônica/terapia , Terapia por Exercício/métodos , Dor Lombar/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estimulação Transcraniana por Corrente Contínua/métodos , Brasil , Dor Crônica/psicologia , Terapia Combinada/métodos , Método Duplo-Cego , Terapia por Exercício/psicologia , Medo , Humanos , Dor Lombar/psicologia
11.
J Neuroeng Rehabil ; 17(1): 72, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32527268

RESUMO

BACKGROUND: Dual transcranial direct current stimulation (tDCS) to the bilateral primary motor cortices (M1s) has potential benefits in chronic stroke, but its effects in subacute stroke, when behavioural effects might be expected to be greater, have been relatively unexplored. Here, we examined the neurophysiological effects and the factors influencing responsiveness of dual-tDCS in subacute stroke survivors. METHODS: We conducted a randomized sham-controlled crossover study in 18 survivors with first-ever, unilateral subcortical ischaemic stroke 2-4 weeks after stroke onset and 14 matched healthy controls. Participants had real dual-tDCS (with an ipsilesional [right for controls] M1 anode and a contralesional M1 [left for controls] cathode; 2 mA for 20mins) and sham dual-tDCS on separate days, with concurrent paretic [left for controls] hand exercise. Using transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG), we recorded motor evoked potentials (MEPs), the ipsilateral silent period (iSP), short-interval intracortical inhibition, and finger movement-related cortical oscillations before and immediately after tDCS. RESULTS: Stroke survivors had decreased excitability in ipsilesional M1 with a relatively excessive transcallosal inhibition from the contralesional to ipsilesional hemisphere at baseline compared with controls, as quantified by decreased MEPs and increased iSP duration. Dual-tDCS led to increased MEPs and decreased iSP duration in ipsilesional M1. The magnitude of the tDCS-induced MEP increase in stroke survivors was predicted by baseline contralesional-to-ipsilesional transcallosal inhibition (iSP) ratio. Baseline post-movement synchronization in α-band activity in ipsilesional M1 was decreased after stroke compared with controls, and its tDCS-induced increase correlated with upper limb score in stroke survivors. No significant adverse effects were observed during or after dual-tDCS. CONCLUSIONS: Task-concurrent dual-tDCS in subacute stroke can safely and effectively modulate bilateral M1 excitability and inter-hemispheric imbalance and also movement-related α-activity.


Assuntos
Córtex Motor/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua/métodos , Adulto , Idoso , Estudos Cross-Over , Potencial Evocado Motor/fisiologia , Feminino , Humanos , Magnetoencefalografia/métodos , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Estimulação Magnética Transcraniana/métodos , Extremidade Superior
12.
Medicine (Baltimore) ; 99(24): e20439, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541465

RESUMO

BACKGROUNDS: Previous studies indicated inconsistent results for the treatment effect of repetitive transcranial magnetic stimulation (rTMS) on post-stroke aphasics. The study conducted a meta-analysis to evaluate whether the rTMS with different frequencies demonstrated any effect in patients with post-stroke aphasia. METHODS: Electronic databases (PubMed, Web of Science, Medline, EMBASE, and Google Scholar) were searched for articles published before July 2019. Statistical analyses were made using STATA 12.0 software. Standard mean difference (SMD) with 95% confidence intervals (CI) were calculated for the treatment effect of rTMS on post-stroke aphasia. RESULTS: Meta-analysis indicated significant treatment effects on naming of rTMS in post-stroke aphasics (SMD 0.76, 95%CI 0.16 to 1.36, I = 76.9%, P < .001). Subgroup analyses showed significant treatment effects on naming of low frequency (LF)-rTMS (SMD 0.40, 95%CI 0.10 to 0.69, I = 0.0%, P = .671). However, the changes in repetition and comprehension following stimulation were not significant. CONCLUSIONS: In conclusion, we provide preliminary evidence that both LF-rTMS and high-frequency-rTMS might be relatively effective and safe treatment for post-stroke aphasics. However, LF-rTMS mainly plays a short-term role in subacute post-stroke aphasics. Longer-term and large-scale studies are essential to explore the effect of rTMS with different frequencies on post-stroke aphasia.


Assuntos
Afasia/etiologia , Afasia/terapia , Acidente Vascular Cerebral/complicações , Estimulação Transcraniana por Corrente Contínua/métodos , Estudos de Casos e Controles , Compreensão/fisiologia , Feminino , Humanos , Masculino , Sensibilidade e Especificidade , Resultado do Tratamento
13.
J Neuroeng Rehabil ; 17(1): 73, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32539812

RESUMO

BACKGROUND: Non-invasive brain stimulation techniques have been shown in several studies to improve the motor recovery of the affected upper-limbs in stroke patients. This study aims to investigate whether or not cathodal transcranial direct current stimulation (c-tDCS), combined with virtual reality (VR), is superior to VR alone in reducing motor impairment and improving upper limb function and quality of life in stroke patients. METHODS: Forty patients who suffered ischemic stroke between 2 weeks to 12 months were recruited for this single-blind randomized control trial. The patients were randomly assigned either to an experimental group who receiving c-tDCS and VR, or a control group receiving sham stimulation and VR. The cathodal electrode was positioned over the primary motor cortex (M1) of the unaffected hemisphere. The treatment session consisted of 20 min of daily therapy, for 10 sessions over a 2-week period. The outcome measures were the Fugl-Meyer Upper Extremity (FM-UE), the Action Research Arm Test (ARAT) and the Barthel Index (BI). RESULTS: The two groups were comparable in demographic characteristic and motor impairment. After 2 weeks of intervention, both groups demonstrated significant improvement in FM-UE, ARAT and BI scores (P<0.05).The experiment group demonstrated more improvement in FM-UE than the control group (10.1 vs. 6.4, p = 0.003) and, ARAT (7.0 vs 3.6, p = 0.026) and BI (12.8 vs 8.5, p = 0.043). CONCLUSIONS: The findings from our study support that c-tDCS, along with VR, can facilitate a stronger beneficial effect on upper limb motor impairment, function and quality of life than VR alone in patients with ischemic stroke. TRIAL REGISTRATION: The study was registered in the Chinese Clinical Trial Registry (ChiCTR1800019386) in November 8, 2018-Retrospectively registered.


Assuntos
Recuperação de Função Fisiológica/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral , Estimulação Transcraniana por Corrente Contínua/métodos , Terapia de Exposição à Realidade Virtual/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiopatologia , Método Simples-Cego , Acidente Vascular Cerebral/fisiopatologia , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Extremidade Superior/fisiopatologia
14.
J Neuroeng Rehabil ; 17(1): 74, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32539819

RESUMO

BACKGROUND: Pharmacologic therapy is the primary treatment used to manage Parkinson's disease (PD) symptoms. However, it becomes less effective with time and some symptoms do not respond to medication. Complementary interventions are therefore required for PD. Recent studies have implemented transcranial direct current stimulation (tDCS) in combination with other modalities of interventions, such as physical and cognitive training. Although the combination of tDCS with physical and cognitive training seems promising, the existing studies present mixed results. Therefore, a systematic review of the literature is necessary. AIMS: This systematic review aims to (i) assess the clinical effects of tDCS when applied in combination with physical or cognitive therapies in people with PD and; (ii) analyze how specific details of the intervention protocols may relate to findings. METHODS: The search strategy detailed the technique of stimulation, population and combined interventions (i.e. cognitive and/or physical training). Only controlled studies were included. RESULTS: Seventeen of an initial yield of 408 studies satisfied the criteria. Studies involved small sample sizes. tDCS protocols and characteristics of combined interventions varied. The reviewed studies suggest that synergistic effects may be obtained for cognition, upper limb function, gait/mobility and posture when tDCS is combined with cognitive and/or motor interventions in PD. CONCLUSION: The reported results encourage further research to better understand the therapeutic utility of tDCS and to inform optimal clinical use in PD. Future studies in this field should focus on determining optimal stimulation parameters and intervention characteristics for maximal benefits in people with PD.


Assuntos
Doença de Parkinson/terapia , Estimulação Transcraniana por Corrente Contínua/métodos , Humanos , Masculino
15.
PLoS One ; 15(6): e0233903, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32516316

RESUMO

OBJECTIVE: Transcranial direct-current stimulation (tDCS) is a noninvasive approach that can alter brain excitability. Several studies have shown the effectiveness of tDCS in improving language and movement function in stroke patients. However, the effect of tDCS on cognitive function after stroke remains uncertain. METHODS: We searched Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the China National Knowledge Infrastructure, the China Science and Technology Journal Database, and the Wanfang Data Knowledge Service Platform from inception to April 2, 2019. Two reviewers independently screened the studies, extracted the data, and evaluated the quality of the included studies using the Cochrane Collaboration Risk of Bias Tool. All statistical analyses were performed in RevMan 5.3, and the mean difference (MD) or standard mean difference (SMD) were used as the pooled statistics. RESULTS: Fifteen studies involving 820 participants were included. When compared with passive tDCS, anodal tDCS was associated with improved general cognitive performance as examined by the Minimum Mental State Examination or Montreal Cognitive Assessment (SMD = 1.31, 95% CI 0.91-1.71, P < 0.00001), attention performance (SMD = 0.66, 95% CI 0.11-1.20, P = 0.02). There was no significant difference in memory performance (SMD = 0.41, 95% CI -0.67-1.50, P = 0.46). CONCLUSIONS: tDCS is likely to be effective for patients with cognitive impairment after stroke. The evidence for different effects based on population characteristics and stimulation methods was limited, but a real effect cannot be ruled out. More high-quality research in this field is required to determine the potential benefits of tDCS in the treatment of cognitive deficits after stroke and to establish the optimal treatment program.


Assuntos
Cognição , Disfunção Cognitiva/terapia , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua/métodos , Humanos
16.
Brain Stimul ; 13(4): 1124-1149, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32413554

RESUMO

BACKGROUND: The COVID-19 pandemic has broadly disrupted biomedical treatment and research including non-invasive brain stimulation (NIBS). Moreover, the rapid onset of societal disruption and evolving regulatory restrictions may not have allowed for systematic planning of how clinical and research work may continue throughout the pandemic or be restarted as restrictions are abated. The urgency to provide and develop NIBS as an intervention for diverse neurological and mental health indications, and as a catalyst of fundamental brain research, is not dampened by the parallel efforts to address the most life-threatening aspects of COVID-19; rather in many cases the need for NIBS is heightened including the potential to mitigate mental health consequences related to COVID-19. OBJECTIVE: To facilitate the re-establishment of access to NIBS clinical services and research operations during the current COVID-19 pandemic and possible future outbreaks, we develop and discuss a framework for balancing the importance of NIBS operations with safety considerations, while addressing the needs of all stakeholders. We focus on Transcranial Magnetic Stimulation (TMS) and low intensity transcranial Electrical Stimulation (tES) - including transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS). METHODS: The present consensus paper provides guidelines and good practices for managing and reopening NIBS clinics and laboratories through the immediate and ongoing stages of COVID-19. The document reflects the analysis of experts with domain-relevant expertise spanning NIBS technology, clinical services, and basic and clinical research - with an international perspective. We outline regulatory aspects, human resources, NIBS optimization, as well as accommodations for specific demographics. RESULTS: A model based on three phases (early COVID-19 impact, current practices, and future preparation) with an 11-step checklist (spanning removing or streamlining in-person protocols, incorporating telemedicine, and addressing COVID-19-associated adverse events) is proposed. Recommendations on implementing social distancing and sterilization of NIBS related equipment, specific considerations of COVID-19 positive populations including mental health comorbidities, as well as considerations regarding regulatory and human resource in the era of COVID-19 are outlined. We discuss COVID-19 considerations specifically for clinical (sub-)populations including pediatric, stroke, addiction, and the elderly. Numerous case-examples across the world are described. CONCLUSION: There is an evident, and in cases urgent, need to maintain NIBS operations through the COVID-19 pandemic, including anticipating future pandemic waves and addressing effects of COVID-19 on brain and mind. The proposed robust and structured strategy aims to address the current and anticipated future challenges while maintaining scientific rigor and managing risk.


Assuntos
Pesquisa Biomédica/métodos , Assistência à Saúde/métodos , Doenças do Sistema Nervoso/terapia , Telemedicina/métodos , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Magnética Transcraniana/métodos , Idoso , Comportamento Aditivo/terapia , Betacoronavirus , Encéfalo/fisiologia , Criança , Ensaios Clínicos como Assunto , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Acidente Vascular Cerebral/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia
17.
J Clin Neurosci ; 77: 128-133, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32402609

RESUMO

Cranial electrical stimulation (CES) is a noninvasive brain stimulation technique that has been shown to improve pain. However, few studies have investigated the potential benefits associated with remotely supervised CES in older adults with knee osteoarthritis (OA). The aim of this study was to examine the feasibility and preliminary efficacy of remotely supervised CES via secure videoconferencing software on clinical pain severity, experimental pain sensitivity, and pain-related cortical response in older adults with knee OA. Thirty participants with symptomatic knee OA pain were randomly assigned to receive 10 daily sessions (60 min each) of remotely supervised CES (n = 15) or sham CES (n = 15) over two weeks. We measured clinical pain severity via a Numeric Rating Scale, experimental pain sensitivity (e.g., heat pain sensitivity, pressure pain sensitivity, and conditioned pain modulation) using quantitative sensory testing, and pain-related cortical response via functional near-infrared spectroscopy imaging. We also measured participant satisfaction with treatment using the Client Satisfaction Questionnaire. Active CES significantly reduced scores on the Numeric Rating Scale and increased heat pain threshold, pressure pain thresholds, and conditioned pain modulation. We also found significant changes in pain-related cortical hemodynamic activity after CES. Participants tolerated CES well without serious adverse effects and were satisfied with the treatment. Our findings demonstrate promising clinical efficacy of remotely supervised CES for older adults with knee OA.


Assuntos
Osteoartrite do Joelho/terapia , Manejo da Dor/métodos , Estimulação Transcraniana por Corrente Contínua/métodos , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/efeitos adversos , Limiar da Dor , Projetos Piloto , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Resultado do Tratamento
18.
J Clin Neurosci ; 78: 296-300, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32402616

RESUMO

Transcranial alternating current stimulation (tACS) is a non-invasive method of brain stimulation that modulates oscillatory neural activity in the cortical area under the electrodes. Gamma (γ)-tACS applied over the primary motor cortex (M1) and cerebellar hemisphere is known to improve motor performance; however, it is not yet known whether it affects motor learning. Thus, here we investigated whether γ-tACS applied over the M1 and cerebellar hemisphere affects motor learning. This study involved 30 healthy subjects (14 females, 16 males) performing a visuomotor control task (eight trials) during an administration of either γ-tACS or a sham stimulation (15 subjects per condition) over their right M1 and left cerebellar hemisphere. Each subject performed five trials after 24 h. The motor learning efficiency, motor learning retention and re-motor learning efficiency in each condition were compared. The motor learning retention in the γ-tACS condition was significantly higher than that in the sham condition (p = 0.031). Thus, subjects who were administered γ-tACS maintained their motor performance the next day better than sham-stimulated subjects. There was no significant difference between the conditions in the motor learning efficiency and those in the re-motor learning efficiency. Our results demonstrate that γ-tACS administered over the M1 and cerebellar hemisphere during a motor learning task can enhance motor learning retention.


Assuntos
Cerebelo/fisiologia , Aprendizagem/fisiologia , Córtex Motor/fisiologia , Desempenho Psicomotor/fisiologia , Estimulação Transcraniana por Corrente Contínua/métodos , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
19.
Psychiatry Res ; 288: 112974, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32353694

RESUMO

Schizophrenia is characterised by delusions, hallucinations, anhedonia and apathy; while impairments in social cognition are often less recognised. Poor social cognition can lead to difficulties in obtaining and maintaining employment, academic progression, interpersonal relationships, and community functioning. Current interventions are highly intensive, require significant resources and have only modest effects on functional outcomes. Virtual reality (VR) and non-invasive brain stimulation (NIBS) may have a role in addressing these limitations. VR allows treatments that are potentially more accessible, less delivery intensive, and have higher ecological validity. While NIBS is able to directly modulate activity in social brain areas in order to promote neuroplasticity, strengthen neural connections and enhance brain function related to social cognitive behaviours. Therefore, the combination of VR and NIBS may allow for more efficient and transferrable interventions than those currently available. This review will explore the potential role of these technologies in the treatment of social cognitive impairment.


Assuntos
Cognição/fisiologia , Esquizofrenia/terapia , Comportamento Social , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Magnética Transcraniana/métodos , Terapia de Exposição à Realidade Virtual/métodos , Encéfalo/fisiopatologia , Humanos , Relações Interpessoais , Esquizofrenia/fisiopatologia
20.
J Clin Neurosci ; 78: 277-283, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32389548

RESUMO

INTRODUCTION: Fatigue is one of the most common disabling symptoms in patients with multiple sclerosis (MS) which is present in 75% of these patients and is usually associated with functional disabilities. According to the literature, there is no general agreement on the effectiveness of the existing treatments for fatigue in patients with MS. As transcranial direct current stimulation (tDCS) is a relatively new method in the treatment of fatigue symptoms in patients with MS, the purpose of this study was to systematically review published evidence conducted to assess the effects of tDCS on fatigue in patients with MS. MATERIAL & METHODS: A thorough literature search of published articles was conducted from 1996 to 2019 in different databases including PubMed, Science Direct, OVID, Google Scholar, Cochrane Library, Scopus, Embase, ProQuest and web of science with keywords of "tDCS", "multiple Sclerosis" and "Fatigue". Results yielded 1017 studies, which after excluding articles based on duplication and title and abstract, 8 of them were selected for review in this study. RESULTS: The results from the literature revealed that six studies indicated positive effects of tDCS stimulation on fatigue reduction. In four studies stimulation was over the right dorsolateral prefrontal cortex (DLPFC); in three studies stimulation placed over the whole body's primary somatosensory cortex (S1); and in one study stimulation applied over the posterior parietal cortex. In most studies, no serious side effects were reported. CONCLUSION: Most studies revealed that tDCS can reduce the adverse effects of MS-related fatigue in particular cognitive type. As follow-ups were either absent or short period, as well as the application of treatment protocols and measurement instruments were different, it was very difficult to draw strong conclusion on the effects of tDCS in patients with MS. However, further large scale studies with long term follow-up are still recommended.


Assuntos
Fadiga/terapia , Esclerose Múltipla/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Estimulação Transcraniana por Corrente Contínua/métodos , Fadiga/etiologia , Fadiga/psicologia , Humanos , Esclerose Múltipla/complicações , Esclerose Múltipla/psicologia , Estimulação Transcraniana por Corrente Contínua/tendências , Resultado do Tratamento
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