No effect of tDCS of the primary motor cortex on isometric exercise performance or perceived fatigue

Anodal transcranial direct current stimulation (tDCS) of the primary motor cortex has been reported to improve isometric exercise performance without changing corticospinal excitability. One possible cause for this may be the previous use of relatively high (2 mA) current intensities, which have inconsistent effects on corticospinal excitability. The present pre‐registered study aimed to replicate previously reported ergogenic effects of 2 mA tDCS and examine whether 1 mA anodal tDCS both improved isometric exercise performance and perceived fatigue, and more reliably altered corticospinal excitability. On three separate occasions, participants performed a sustained submaximal isometric knee extension until failure after receiving either 1, 2 mA or sham anodal tDCS. Corticospinal excitability of the knee extensors was measured using transcranial magnetic stimulation immediately before and after tDCS. Rating of fatigue was recorded throughout the isometric exercise. Neither 1 nor 2 mA tDCS improved exercise performance, or reduced perceived fatigue, compared with sham stimulation. There was also no effect of tDCS on the corticospinal excitability of the knee extensors. We found no effect of tDCS on either exercise performance, perceived fatigue or corticospinal excitability. This study adds to the growing body of literature reporting no ergogenic effect of tDCS. Large pre‐registered replications of previously reported effects are now required before tDCS can be considered an effective method to improve exercise performance.     

tDCS potentiation provides no evidence for a link between right dorsal–lateral prefrontal cortical activity and empathic responding

Previous studies suggest the dorsolateral prefrontal cortex (DLPFC) is involved in processing of empathic concern. This has not been experimentally tested to date. We tested the hypotheses that electrical potentiation in the right DLPFC would be associated with increased empathic concern and prosocial behavior. Participants were randomly allocated to one of three transcranial Direct Current Stimulation (tDCS) conditions: (a) relative right potentiation, (b) relative left potentiation, and (c) sham. Participants viewed images of African children in distressing circumstances, and completed measures of empathic concern pre- and post-tDCS manipulation. Contrary to our prediction, neither effects, nor interactions of heightened empathic concern were observed. These results conflict with previous studies using this bilateral tDCS montage. Explanations could be that stimulation used in this study had been simply too weak (1.5 mA). Alternatively, the area of the DLPFC involved in emotion regulation is closer to the cortex than the area involved in empathic concern, and more easily potentiated by tDCS. Therefore, the DLPFC potentiation in the present study may have linked empathic concern with adaptive emotion regulation strategies. Future research could examine this possibility using measures of emotion regulation and higher fidelity neurostimulation (e.g., repetitive Transcranial Magnetic Stimulation [rTMS]).     

The neural components of empathy: Predicting daily prosocial behavior

Previous neuroimaging studies on empathy have not clearly identified neural systems that support the three components of empathy: affective congruence, perspective-taking, and prosocial motivation. These limitations stem from a focus on a single emotion per study, minimal variation in amount of social context provided, and lack of prosocial motivation assessment. In the current investigation, 32 participants completed a functional magnetic resonance imaging session assessing empathic responses to individuals experiencing painful, anxious, and happy events that varied in valence and amount of social context provided. They also completed a 14-day experience sampling survey that assessed real-world helping behaviors. The results demonstrate that empathy for positive and negative emotions selectively activates regions associated with positive and negative affect, respectively. In addition, the mirror system was more active during empathy for context-independent events (pain), whereas the mentalizing system was more active during empathy for context-dependent events (anxiety, happiness). Finally, the septal area, previously linked to prosocial motivation, was the only region that was commonly activated across empathy for pain, anxiety, and happiness. Septal activity during each of these empathic experiences was predictive of daily helping. These findings suggest that empathy has multiple input pathways, produces affect-congruent activations, and results in septally mediated prosocial motivation.     

Anodal tDCS targeting the right orbitofrontal cortex enhances facial expression recognition

The orbitofrontal cortex (OFC) has been implicated in the capacity to accurately recognise facial expressions. The aim of the current study was to determine if anodal transcranial direct current stimulation (tDCS) targeting the right OFC in healthy adults would enhance facial expression recognition, compared with a sham condition. Across two counterbalanced sessions of tDCS (i.e. anodal and sham), 20 undergraduate participants (18 female) completed a facial expression labelling task comprising angry, disgusted, fearful, happy, sad and neutral expressions, and a control (social judgement) task comprising the same expressions. Responses on the labelling task were scored for accuracy, median reaction time and overall efficiency (i.e. combined accuracy and reaction time). Anodal tDCS targeting the right OFC enhanced facial expression recognition, reflected in greater efficiency and speed of recognition across emotions, relative to the sham condition. In contrast, there was no effect of tDCS to responses on the control task. This is the first study to demonstrate that anodal tDCS targeting the right OFC boosts facial expression recognition. This finding provides a solid foundation for future research to examine the efficacy of this technique as a means to treat facial expression recognition deficits, particularly in individuals with OFC damage or dysfunction.     

Motor Cortex Stimulation for Pain: A Narrative Review of Indications,Techniques, and Outcomes

BackgroundMotor cortex stimulation (MCS) was introduced in 1985 and has been tested extensively for different types of peripheral and central neuropathic pain syndromes (eg, central poststroke pain, phantom limb pain, trigeminal neuropathic pain, migraines, etc). The motor cortex can be stimulated through different routes, including subdural, epidural, and transcranial.ObjectivesIn this review, we discuss the current uses, surgical techniques, localization techniques, stimulation parameters, and clinical outcomes of patients who underwent chronic MCS for treatment-resistant pain syndromes.Materials and MethodsA broad literature search was conducted through PubMed to include all articles focusing on MCS for pain relief (keywords: subdural, epidural, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, motor cortex stimulation, pain).Literature ReviewEpidural MCS was the most widely used technique and had varying response rates across studies. Long-term efficacy was limited, and pain relief tended to decrease over time. Subdural MCS using similar stimulation parameters demonstrated similar efficacy to epidural stimulation and less invasive methods, such as repetitive transcranial magnetic stimulation (rTMS), which have been shown to provide adequate pain relief. rTMS and certain medications (ketamine and morphine) have been shown to predict the long-term response to epidural MCS. Complications tend to be rare, the most reported being seizures during subdural or epidural stimulation or hardware infection.ConclusionsScientific evidence supports the use of MCS for treatment of refractory neuropathic pain syndromes. Further studies are warranted to elucidate the specific indications and stimulation protocols that are most amenable to the different types of MCS.     

Cerebellar tDCS does not affect performance in the N-back task

The N-back task is widely used in cognitive research. Furthermore, the cerebellum’s role in cognitive processes is becoming more widely recognized. Studies using transcranial direct current stimulation (tDCS) have demonstrated effects of cerebellar stimulation on several cognitive tasks. Therefore, the aim of this study was to investigate the effects of cerebellar tDCS on cognitive performance by using the N-back task. The cerebellum of 12 participants was stimulated during the task. Moreover, the cognitive load was manipulated in N = 2, N = 3, and N = 4. Every participant received three tDCS conditions (anodal, cathodal, and sham) divided over three separated days. It was expected that anodal stimulation would improve performance on the task. Each participant performed 6 repetitions of every load in which correct responses, false alarms, and reaction times were recorded. We found significant differences between the three levels of load in the rate of correct responses and false alarms, indicating that subjects followed the expected pattern of performance for the N-back task. However, no significant differences between the three tDCS conditions were found. Therefore, it was concluded that in this study cognitive performance on the N-back task was not readily influenced by cerebellar tDCS, and any true effects are likely to be small. We discuss several limitations in task design and suggest future experiments to address such issues.     

The COMT Val158Met polymorphism does not modulate the after‐effect of tDCS on working memory

Transcranial direct current stimulation (tDCS) can alter cortical excitability, neural plasticity, and cognitive‐behavioral performance; however, its effects are known to vary across studies. A partial account of this variability relates to individual differences in dopamine function. Indeed, dopaminergic manipulations alter the physiological and cognitive‐behavioral effects of tDCS, and gene polymorphisms related to dopamine have predicted individual response to online tDCS (i.e., stimulation overlapping with the critical task). Notably, the role of individual differences in dopamine has not yet been properly assessed in the effect of offline tDCS (i.e., stimulation prior to the critical task). We investigated if and how the COMT Val¹⁵⁸Met polymorphism (rs4680) modulates the after‐effect of prefrontal tDCS on verbal working memory (WM). One hundred and thirty‐nine participants were genotyped for the COMT Val¹⁵⁸Met polymorphism and received anodal‐over‐left, cathodal‐over‐right (AL‐CR), cathodal‐over‐left, anodal‐over‐right (CL‐AR), or sham stimulation over the dorsolateral prefrontal cortex in a between‐subjects, pretest–posttest study design. WM was assessed using the N‐back task. The results provide no evidence that the COMT polymorphism impacts the after‐effect of prefrontal tDCS on WM. Taken together with previous findings on dopamine and tDCS interactions, the results of the present study suggest that (a) indirect markers of dopamine (such as COMT) are differently related to online and offline effects of tDCS, and (b) findings from studies involving pharmacological manipulation should be generalized with caution to findings of inter‐individual differences. In sum, we argue that state (i.e., a manipulation of) and trait (i.e., baseline) differences in dopamine may exert different effects on online and offline tDCS.     

The Analgesic Effect of Transcranial Direct Current Stimulation in Fibromyalgia: A Systematic Review,Meta-Analysis,and Meta-Regression of Potential Influencers of Clinical Effect

BackgroundThere is tentative evidence to support the analgesic effect of transcranial direct current stimulation (tDCS) in fibromyalgia (FM), with large variability in the effect size (ES) encountered in different clinical trials. Understanding the source of the variability and exploring how it relates to the clinical results could characterize effective neuromodulation protocols and ultimately guide care in FM pain. The primary objective of this study was to determine the effect of tDCS in FM pain as compared with sham tDCS. The secondary objective was to explore the relationship of methodology, population, and intervention factors and the analgesic effect of tDCS in FM.Materials and MethodsFor the primary objective, a systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized clinical trials (RCTs) investigating tDCS as an intervention for FM pain were searched in MEDLINE, Embase, and the Web Of Science. Studies were excluded if they used cross-over designs or if they did not use tDCS as an intervention for pain or did not measure clinical pain. Analysis for the main outcome was performed using a random-effects model. Risk of bias and evidence certainty were assessed for all studies using Cochrane Risk of Bias and Grading of Recommendations Assessment, Development, and Evaluation tools. For the secondary objective, a meta-regression was conducted to explore methodology, population, and intervention factors potentially related to the ES.ResultsSixteen RCTs were included. Six studies presented a high risk of bias. Significant reduction in pain scores were found for FM (standardized mean difference = 1.22, 95% CI = 0.80−1.65, p < 0.001). Subgroup analysis considering tDCS as a neural target revealed no differences between common neural sites. Meta-regression revealed that the duration of the tDCS protocol in weeks was the only factor associated with the ES, in which protocols that lasted four weeks or longer reported larger ES than shorter protocols.ConclusionsResults suggest an analgesic effect of tDCS in FM. tDCS protocols that last four weeks or more may be associated with larger ESs. Definite conclusions are inadequate given the large heterogeneity and limited quality of evidence of the included studies.     

Non-invasive Brain Stimulation Therapy in Multiple Sclerosis: A Review of tDCS,rTMS and ECT Results

BackgroundMultiple sclerosis (MS) is a disabling neurological disorder presenting a variety of symptoms which are hard to control by actual drug regimens. Non-invasive brain stimulation (NIBS) techniques have been investigated in the past years for the improvement of several neurologic and psychiatric disorders.ObjectiveHere, we review the application of transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (rTMS, iTBS) and electroconvulsive therapy (ECT) in MS patients.MethodsArticles were searched in common literature databases. Crosslinks were reviewed.ResultsECT was shown to be efficacious for the treatment of severe psychiatric disorders in 21 case reports. The results of tDCS and TMS for the treatment of depressive symptoms, fatigue, tactile sensory deficit, pain, motor performance, and spasticity were assessed in several studies and showed mixed results.ConclusionsOverall, data for the treatment of MS with NIBS is sparse regarding TMS and tDCS. Treatment of severe psychiatric disorders with ECT is only reported in single cases. More studies are needed to elucidate the potential role of NIBS in MS treatment.     

Brain stimulation: a therapeutic approach for the treatment of neurological disorders

Brain stimulation has become one of the most acceptable therapeutic approaches in recent years and a powerful tool in the remedy against neurological diseases. Brain stimulation is achieved through the application of electric currents using non-invasive as well as invasive techniques. Recent technological advancements have evolved into the development of precise devices with capacity to produce well-controlled and effective brain stimulation. Currently, most used non-invasive techniques are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), whereas the most common invasive technique is deep brain stimulation (DBS). In last decade, application of these brain stimulation techniques has not only exploded but also expanded to wide variety of neurological disorders. Therefore, in the current review, we will provide an overview of the potential of both non-invasive (rTMS and tDCS) and invasive (DBS) brain stimulation techniques in the treatment of such brain diseases.     

Effects of a single session of transcranial direct current stimulation on upper limb movements in children with cerebral palsy: A randomized,sham-controlled study

ABSTRACT

Introduction: Motor impairment in children with spastic hemiparetic cerebral palsy (CP) is generally more prominent in the affected upper limb, leading to limitations in hand function stemming from deficiencies in motor coordination and selective motor control as well as muscle weakness, slower execution of movements and deficient integration of sensory-motor information. Objective: Determine the effect of a single session of anodal transcranial direct current stimulation (tDCS) combined with functional training on the spatiotemporal variables of upper arm movements in children with spastic hemiparesis. Method: A randomized, sham-controlled trial with a blinded evaluator was conducted involving 20 children with CP between 6 and 12 years of age. The spatiotemporal variables of the upper limbs were analyzed by comparing the results of Evaluation 1 (before stimulation) and Evaluation 2 (immediately after stimulation). The protocol consisted of a 20-minute session of functional training of the paretic upper limb combined with tDCS administered over the primary motor cortex of the hemisphere contralateral to the motor impairment at an intensity of 1 mA. The participants were randomly allocated to two groups: experimental group (anodal tDCS) and control group (sham tDCS). Results: Statistically significant (p < 0.05) reductions in total movement duration and returning movement duration were found in both the paretic and non-paretic limbs in the group submitted to active tDCS. No significant differences were found in the control group for any of the variables analyzed. Conclusion: A single session of anodal tDCS over the primary motor cortex of the hemisphere ipsilateral to the brain lesion led to momentary motor improvements in both upper limbs of the children with spastic hemiparetic CP analyzed in the present study.     

Transient tinnitus suppression induced by repetitive transcranial magnetic stimulation and transcranial direct current stimulation

Modulation of activity in the left temporoparietal area (LTA) by 10 Hz repetitive transcranial magnetic stimulation (rTMS) results in a transient reduction of tinnitus. We aimed to replicate these results and test whether transcranial direct current stimulation (tDCS) of LTA could yield similar effect. Patients with tinnitus underwent six different types of stimulation in a random order: 10-Hz rTMS of LTA, 10-Hz rTMS of mesial parietal cortex, sham rTMS, anodal tDCS of LTA, cathodal tDCS of LTA and sham tDCS. A non-parametric analysis of variance showed a significant main effect of type of stimulation ( P  = 0.002) and post hoc tests showed that 10-Hz rTMS and anodal tDCS of LTA resulted in a significant reduction of tinnitus. These effects were short lasting. These results replicate the findings of the previous study and, in addition, show preliminary evidence that anodal tDCS of LTA induces a similar transient tinnitus reduction as high-frequency rTMS.     

Challenges of proper placebo control for non‐invasive brain stimulation in clinical and experimental applications

A range of techniques are now available for modulating the activity of the brain in healthy people and people with neurological conditions. These techniques, including transcranial magnetic stimulation (TMS) and transcranial current stimulation (tCS, which includes direct and alternating current), create magnetic or electrical fields that cross the intact skull and affect neural processing in brain areas near to the scalp location where the stimulation is delivered. TMS and tCS have proved to be valuable tools in behavioural neuroscience laboratories, where causal involvement of specific brain areas in specific tasks can be shown. In clinical neuroscience, the techniques offer the promise of correcting abnormal activity, such as when a stroke leaves a brain area underactive. As the use of brain stimulation becomes more commonplace in laboratories and clinics, we discuss the safety and ethical issues inherent in using the techniques with human participants, and we suggest how to balance scientific integrity with the safety of the participant.     

Non-invasive brain stimulation (rTMS and tDCS) in patients with aphasia: Mode of action at the cellular level

A high proportion of patients who have suffered a stroke also suffer from aphasia. Approximately half of those affected will remain in this state despite intensive language therapy. Non-invasive brain stimulation allows us to directly and focally stimulate areas of the brain. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), methods used in the treatment of aphasia, are based on an imbalance of mutual interhemispheric inhibition. In open and sham-controlled studies, a low-frequency, 1 Hz stimulation of the non-lesioned hemisphere (the homologue of Broca's area) for a week or more significantly improved spontaneous speech and anomia in patients with non-fluent aphasia. These positive outcomes from rTMS stimulation developed slowly, often over months following treatment, and persisted. Effects of intermittent theta burst stimulation (iTBS) developed faster than the low-frequency stimulation, and high-activity enhancement was detected in the left hemisphere after the stimulation of Broca's region. Both types of tDCS stimulation resulted in improved comprehension and reduced anomia, their primary modes of action are distinct, however, both share a common site of action with regard to the balance that occurs between inhibitory and excitatory neurotransmitters (synaptic and non-synaptic). Both types of non-invasive stimulation prepare the lesioned brain for better outcome.     

Task load modulates tDCS effects on language performance

Transcranial direct current stimulation (tDCS) effects in cognition are inconsistent across studies. This study aimed to discuss why typical models might be insufficient to explain these effects, and to investigate a brain state factor, task load, with behavioral experiments on phonological processing. The motor theory of speech perception states that motor codes for articulation take part in speech perception, a view sharpened by neuroimaging findings, which show that the motor role in phonological processing is weighted by the nature of the tasks. Three groups of 20 participants, each under a different tDCS condition (anodal, cathodal, or sham), performed a categorical perception (CP), a lexical decision (LD), and a word naming (WN) task while stimulated on the pars opercularis of the left inferior frontal gyrus, a language area typically involved with the motor role. These tasks were assumed to be subserved by a network of nodes which included the target, believed to be increasingly relevant for performance from speech perception to speech production. A-tDCS facilitation and C-tDCS downregulation should directly increase with the relevance of the target for the task. Downregulation of a low relevance node could result in facilitation by compensation from other nodes. Overall, our brain stimulation findings support the neuroimaging literature in that motor participation in phonological processing depends on task nature and show that tDCS effects are modulated by task load relative to the target. Outcomes such as the improved performance following cathodal tDCS in CP and WN suggest that compensatory mechanisms may take place when the tasks involve more complex neuronal networks.     

Testing the limits: Investigating the effect of tDCS dose on working memory enhancement in healthy controls

Transcranial Direct Current Stimulation (tDCS) is a non-invasive form of brain stimulation which has been shown to induce changes in brain activity and subsequent functioning. In particular, there is a rapidly growing evidence base showing that anodal tDCS applied to the left prefrontal cortex (PFC) is able to enhance aspects of cognitive functioning, in particular working memory (WM). This has led to both excitement and concerns regarding the possibility of ‘electrodoping’ in order to greatly improve one's cognitive performance. We investigated the behavioural and neurophysiological effects of increasing the current (or ‘dose’) of tDCS on the degree of WM improvement in healthy controls. Single sessions of 1 mA, 2 mA and sham anodal tDCS to the left PFC were undertaken over a period of three weeks. Participants underwent a WM task at three time points post-stimulation (0, 20 and 40 min) with concurrent electrophysiological (EEG) recordings. Our results showed that while active tDCS can enhance behavioural performance, with neurophysiological findings indicating improve efficiency of cognitive processing; we showed that 1 mA produced the most significant effects. These findings are somewhat unexpected as tDCS dose effects in cognitive enhancement have been shown previously in patient populations. Our results provide valuable information regarding the potential limits of tDCS induced cognitive enhancement in healthy controls, as well as providing additional insights into the possible mechanisms of action of tDCS.