血糖升高速度对糖尿病大鼠脑组织基质金属蛋白酶-9水平的影响

目的探讨不同的血糖升高速度对糖尿病大鼠脑组织基质金属蛋白酶-9(MMP-9)水平的影响。方法将30只SD大鼠随机分为空白对照组(Blank组)、假手术组(Sham组)、快速组(Speed(1)组)、较快组(Speed(2)组)、较慢组(Speed(3)组)和慢速组(Speed(4)组),每组5只大鼠。将大鼠制作成糖尿病模型。Blank组大鼠股静脉注射0. 9%氯化钠液,维持血糖在(5. 50±0. 25) mmol/L。Sham组大鼠股静脉注射25%葡萄糖和15 U/kg的胰岛素1. 5 ml/h,维持血糖在(5. 50±0. 25) mmol/L。其余4组大鼠股静脉泵入胰岛素1U/h诱导低血糖并维持1 h,然后泵入25%葡萄糖将血糖升高至5～6 mmol/L并维持1. 5 h。取大脑皮质、海马、丘脑、脑干、小脑脑组织,采用免疫印迹法检测MMP-9蛋白的表达。结果在皮质、海马、丘脑组织中,Speed(1)组和Speed(4)组的前体-MMP-9水平明显高于Sham组和Blank组(均P 0. 05)。在皮质、海马、丘脑组织中,Speed(1)组和Speed(4)组的活性MMP-9水平明显高于Blank组、Sham组、Speed(2)组和Speed(3)组(均P 0. 05); Speed(2)组和Speed(3)组的活性MMP-9水平明显高于Blank组和Sham组(均P 0. 05)。结论低血糖后任何速度的葡萄糖再灌注都会带来脑损伤,但合理的控制葡萄糖再灌注速度或许可减轻脑损伤。     

大鼠颞叶癫痫点燃后海马zif268mRNA及其蛋白的时空表达变化

目的 探讨海马zif268mRNA及其蛋白的时空表达变化与颞叶癫痫脑损伤的关系. 方法 将雄性Wistar大鼠随机分为3组:其中正常组6只,假手术对照组(Sham组)和海人酸(KA)颞叶癫痫点燃组(TLE组)各36只,后两组按点燃后6h、24h、3d、7d、14d、21d时间点各分为6小组,每小组6只.采用KA杏仁核点燃建立经典颞叶癫痫模型,应用原位杂交和免疫组织化学方法分别检测海马神经元zif268mRNA及其蛋白的表达.结果 TLE组zif268mRNA表达在总体上和点燃后远期21d海马CA1、CA3区和齿状同(DG)均高于Sham组(P＜0.05).TLE组Zif268蛋白表达在总体上和远期21d海马DG表达低于Sham组(P＜0.05).回归分析提示颞叶癫痫与海马zif268mRNA表达呈正相关(β=0.286,P＜0.001),与Zif268蛋白表达呈负相关(β=-0.153,P＜0.001).结论 颞叶癫痫大鼠海马zif268mRNA及其蛋白的时空表达变化可能参与颞叶癫痫发病及其脑损伤过程.     

蛛网膜下腔出血后Caspase-12表达及海马细胞凋亡的研究

目的 检测内质网特异性因子Caspase - 12及海马区神经元细胞凋亡的表达,分析内质网应激在自发性蛛网膜下腔出血(SAH)后早期脑损伤中的作用.方法 54只大鼠分为手术组、假手术组、空白对照组;手术组、假手术组又分为3h、12 h、24 h、48 h亚组.利用RT - PCR检测Caspase - 12的表达,TUNEL测大鼠海马区神经元细胞凋亡,电镜及HE染色光镜下观察大鼠海马区神经元细胞形态学改变.结果 Caspase - 12在SAH后3h开始增高,24 h达到高峰,48 h开始降低,但48 h时较假手术组、空白对照组仍高(P＜0.01),各组比较差异有统计学意义(P＜0.01).大鼠海马区神经元凋亡阳性细胞在3h时开始出现,但与假手术组、空白对照组相比差异无统计学意义(P＞0.05),凋亡阳性细胞数在24h达高峰,48 h开始降低,但较假手术组、空白对照组仍高(P＜0.01).各组间比较差异有统计学意义.手术组大鼠海马区神经元细胞在光镜下可见明显核固缩.各组间Caspase - 12的表达量与细胞凋亡阳性数量呈正相关(r=0.753,P＜0.01).结论 内质网应激在SAH后早期脑损伤中发挥重要作用.     

氯硝西泮预处理对癫痫大鼠海马区γ-氨基丁酸A受体γ2亚单位表达的影响

目的 探讨氯硝西泮预处理对癫痫大鼠海马区γ-氨基丁酸A受体γ2亚单位(GABAARγ2)表达的影响.方法 60只健康雄性SD大鼠随机分为假手术组、癫痫组和氯硝西泮预处理组;癫痫组再分为6h、12 h、1 d、3d、7d、15 d和30 d7个亚组;药物预处理组再分为假预处理组、预处理6h、12h和ld亚组.药物预处理组给予氯硝西泮6 mg/(kg·d)分2次灌胃,连续5d;然后癫痫组和预处理组通过向大鼠海马C3区注射海人酸建立颞叶癫痫模型;采用免疫组化法在相应时点检测各组大鼠海马区GABAARγ2的表达.结果 与假手术组比较,癫痫组CA1区癫痫发作ld后、CA3区癫痫发作后各时间点GABAARγ2表达明显下降(P＜0.05 ～0.01).与癫痫组相应亚组比较,预处理6h、12 h亚组海马CA3区及预处理ld亚组海马CA1区及CA3区GABAARγ2的表达明显增高(P＜0.05～0.01).结论 氯硝西泮预处理可上调癫痫大鼠海马区GABAARγ2的表达.     

脑缺血对大鼠皮层及海马铜蓝蛋白表达的影响

目的 探讨脑缺血对大鼠皮层及海马中铜蓝蛋白(Ceruloplasmin,Cp)表达的影响.方法 雄性Wistar大鼠60只,随机分为脑缺血1、3、7、28 d组和假手术对照组,每组各12只.实验组结扎双侧颈总动脉造成大鼠脑缺血,假手术对照组仅分离出双侧颈总动脉但不结扎.采用反转录聚合酶链反应(RT-PCR)检测皮层及海马组织中Cp mRNA的表达,免疫组织化学观察皮层及海马组织中Cp的表达.结果 大鼠皮层和海马均表达Cp mRNA.皮层和海马Cp mRNA的表达随缺血时间的延长逐渐降低,缺血1、3、7、28 d组表达均低于假手术组(P＜0.01).脑组织脉络丛细胞、室管膜细胞、皮层和海马的星形胶质细胞、血管内皮细胞均表达Cp;而皮层和海马的锥体细胞和颗粒细胞均不表达Cp.缺血1 d组皮层及海马Cp表达与对照组差异不显著(P＞0.05);缺血3 d组皮层和海马Cp表达低于假手术组(P＜0.05);缺血第7、28 d组Cp表达减少极为显著(P＜0.01).脑缺血大鼠皮层和海马中铁含量与Cp的表达呈负相关,相关系数分别为-0.831(P＜0.01)和-0.809(P＜0.01).结论 脑缺血可诱导大鼠皮层及海马中Cp表达降低.脑缺血后Cp表达减少可能参与了脑缺血引起的铁含量升高及神经元铁沉积的过程.     

亚低温对大鼠创伤性脑损伤后海马CA3区细胞凋亡及其相关蛋白表达的影响

本研究采用流式细胞仪 (flowcytometer ,FCM )及免疫组化法 ,分别观察亚低温对大鼠创伤性脑损伤 (TBI)后脑海马CA3区细胞凋亡率及Bcl 2、Bax和Caspase 3蛋白表达的影响 ,探讨亚低温抗细胞凋亡的脑保护机制。1　材料和方法1 1　研究对象 :雄性SD大鼠 4 8只 ,体重 350～ 375g ,随机分成空白对照、假手术、单纯脑损伤及脑损伤后亚低温治疗 4组 ,每组1 2只 ,6只用于检测细胞凋亡率 ,另 6只用来观察Bcl 2、Bax及Caspase 3蛋白表达。空白对照组不作任何处理 ,假手术组除了不给予头部打击外 ,其余操作同单纯脑损伤组 ,亚低温治疗组于伤后立…     

炎性细胞因子在早期母子分离对成年后 大鼠认知功能影响中的作用

目的 研究早期母子分离对成年雄性大鼠认知功能的影响,以及海马区炎性细胞因子在 其中的作用,以探讨生命早期应激对神经发育影响的机制。方法 新生SD大鼠随机分成母子分离组（MS 组）和空白对照组（NMS 组）,MS 组幼鼠在出生后第3～22 天,每天与母鼠分离3 h。NMS 组不做处理。 10 周龄时,对两组成年大鼠进行Morris水迷宫行为学测试,NeuN免疫荧光染色观察两组大鼠海马齿状 回（DG 区）正常及变性神经元,GFAP/Iba-1 免疫荧光染色观察星形胶质细胞和小胶质细胞,Ki67/DCX 免 疫荧光染色观察神经元增殖、分化情况,蛋白电泳法检测两组大鼠大脑海马区IL-1β、IL-6、TNF-α含 量。结果 相对于NMS 组,行为学测试提示MS 组大鼠学习、记忆能力下降,表现为MS 组大鼠有更长的 逃逸潜伏期,更少的目标象限停留时间和穿越平台次数（P＜ 0.05）;海马DG 区正常及变性神经元的数目 无明显变化（P ＞ 0.05）,但星形胶质细胞及小胶质细胞的数目增加（P ＜ 0.01）,且神经元增殖减少、分化 减缓（P＜ 0.01）;海马区IL-1β、TNF-α表达增高（P＜ 0.01）,IL-6 表达无明显变化（P＞ 0.05）。结论 生 命早期重复母子分离能够引起大鼠海马区神经炎性反应,增加星形胶质细胞和小胶质细胞数目,增高 海马区炎性细胞因子的表达,导致成年后大鼠认知功能的改变。     

小檗碱对癫痫大鼠脑组织P-糖蛋白表达的影响

目的 探讨小檗碱(BBR)对癫痫大鼠脑组织P-糖蛋白(P-gp)表达的影响.方法 将44只SD大鼠随机分为假手术组(9只)、癫痫组(9只)和BBR 10 mg/kg(9只)、20 mg/kg(9只)、40 mg/kg组(9只).采用大鼠海马注射海人酸方法制作癫痫模型,各BBR干预组分别于术前48 h、术前24h和术后6h腹腔注射相应剂量BBR.观察各组大鼠癫痫发作潜伏期及发作严重程度.造模24 h后,采用免疫组化方法检测并比较各组大鼠海马CA3区P-gp和核因子-κB(NF-κB) p65的表达水平.结果 BBR 20 mg/kg组[(66.11±5.90) min,(26.67±6.67) min]和40 mg/kg组[(76.33±9.11) min,(42.00±7.73) min]大鼠癫痫发作潜伏期及初次至第6次≥Ⅳ级痫样发作间隔时间均明显长于癫痫组[(41.78±10.45) min,(9.44±4.25)min](均P＜0.05).各组大鼠海马CA3区NF-κB p65和P-gp表达的差异均有统计学意义(H=16.024,H=21.830;均P＜0.01).癫痫组海马CA3区NF-κB p65和P-gp表达显著高于假手术组(均P＜0.05);BBR 20mg/kg和40 mg/kg组表达显著低于癫痫组(均P＜0.05).结论 BBR能够延长癫痫发作潜伏期、降低其严重程度,并抑制癫痫大鼠脑组织NF-κB和P-gp的表达.     

亚低温抑制大鼠弥漫性脑损伤后细胞凋亡的研究

目的探讨大鼠不同程度弥漫性脑损伤后脑组织的凋亡变化过程及亚低温治疗对脑细胞凋亡的抑制作用.方法采用大鼠Marmarou颅脑创伤装置制作弥漫性脑损伤模型,然后将128只Wistar大鼠分为未损伤组(对照组)、重度损伤组、轻度损伤组和亚低温治疗组.通过电子显微镜、组织切片原位末端标记DNA片段(TUNEL染色)、琼脂糖凝胶电泳(DNA Ladder法)等方法,观察和比较不同程度脑损伤后,大鼠脑皮层及海马区凋亡细胞的形态、特点和数量.结果(1)损伤后24～48 h,皮层及海马区可见大量细胞皱缩、核碎裂、核不规则等细胞凋亡现象,48 h较24 h更为严重;亚低温治疗后24～48 h,电子显微镜观察皮层及海马区未见细胞皱缩、核碎裂等细胞凋亡现象.(2)TUNEL染色结果显示,随着损伤程度的加重凋亡明显加重,损伤后48 h达高峰,然后逐渐下降.轻度损伤组细胞凋亡主要限于海马CA2和CA3区;重度脑损伤组细胞凋亡涉及整个海马结构,同时还广泛累及额顶区皮质.损伤后第24、48、72 h,皮层及海马区的凋亡细胞数量较同期未治疗组明显减少.(3)重度损伤后48 h,海马和皮层区细胞琼脂糖电泳可见典型的DNA梯状带,其他时间未见梯状带.亚低温治疗组、轻度脑损伤组及未损伤组亦未见梯状带.结论轻度弥漫性脑损伤后,脑细胞凋亡多发生于海马CA2和CA3区;重度脑损伤后皮层及海马区细胞可发生广泛凋亡.细胞凋亡随着损伤程度的加重而加重,高峰位于伤后第2 d.亚低温治疗可有效地抑制大鼠弥漫性脑损伤后的细胞凋亡.     

吡咯烷二硫代氨基甲酸对匹鲁卡品诱导癫痫大鼠海马神经元及小胶质细胞的影响

目的观察吡咯烷二硫代氨基甲酸(PDTC)对匹鲁卡品诱导癫痫大鼠海马CA1、CA3和DG各区神经元及小胶质细胞的影响。方法 30只大鼠随机分为正常对照组(n=6)、癫痫组(n=12)及PDTC干预组(n=12)。采用一次性腹腔注射匹鲁卡品(320 mg/kg)诱导大鼠癫痫发作;PDTC干预组分别于注射匹鲁卡品前24 h、20 min腹腔注射PDTC(100 mg/kg);正常对照组注射等量生理盐水。监测大鼠行为学改变;采用Fluoro-Jade C(FJC)染色法检测海马DG、CA1、CA3区退行性改变神经元;免疫组织化学方法检测各组大鼠海马各区小胶质细胞表达情况。结果癫痫组及PDTC干预组各有10只大鼠制模成功。正常对照组大鼠无癫痫发作;癫痫组大鼠平均跌倒次数[(32.30±4.37)次]显著多于PDTC干预组[(17.50±2.37)次](P0.05)。正常对照组大鼠海马各区未见FJC阳性细胞及少量Iba-1标记的小胶质细胞。与癫痫组比较,正常对照组DG、CA1、CA3锥体层Iba-1标记的小胶质细胞数显著减少(P0.01);PDTC干预组CA1、CA3区FJC阳性细胞数及锥体层Iba-1标记的小胶质细胞数明显减少(P0.05~0.01)。结论 PDTC可能通过抑制小胶质细胞活性,影响小胶质细胞介导的神经炎症反应,从而对癫痫持续状态所致脑损伤起到保护作用,改善癫痫发作的严重程度。     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.