Add-on tDCS Research Articles

Early Boost of Linguistic Skills? Individualized Non-Invasive Brain Stimulation in Early Postacute Aphasia.

Non-invasive brain stimulation, such as transcranial direct current stimulation (tDCS), has been shown to increase the outcome of speech and language therapy (SLT) in chronic aphasia. Only a few studies have investigated the effect of add-on tDCS on SLT in the early stage of aphasia; this may be due to methodological reasons, in particular the influence of spontaneous remission and the difficulty of establishing stimulation protocols in clinical routines. Thirty-seven participants with subacute aphasia (PwA) after stroke (23 men, 14 women; mean age 62 ± 12 years; mean duration 49 ± 28 days) were included in two consecutive periods of treatment lasting two weeks each. During the first period (P1) the participants received 10 sessions of SLT, during the second period (P2) the aphasia therapy was supplemented by anodal left hemispheric 2 mA tDCS over the left hemisphere. Severity-specific language tests (Aachen Aphasia Test (AAT), n = 27 and Bielefeld Aphasia Screening-Reha (BIAS-R), n = 10) were administered before P1, between P1 and P2, and after P2. Where information was available, the results were corrected for spontaneous remission (AAT sample), and the therapy outcomes of P1 and P2 were compared. Participants' overall language abilities improved significantly during P1 and P2. However, improvement-as measured by the AAT profile level or the BIAS-R mean percentage value-during P2 (with tDCS) was significantly higher than during P1 (p < 0.001; AAT sample and p = 0.005; BIAS-R sample). Thus, tDCS protocols can be implemented in early aphasia rehabilitation. Despite the limitations of the research design, which are also discussed from an implementation science perspective, this is preliminary evidence that an individually tailored anodal tDCS can have a significant add-on effect on the outcome of behavioral aphasia therapy in subacute aphasia.

Effects of Transcranial Direct-Current Stimulation (tDCS) Treatment Sessions on Neuropsychological ‎Functioning Among Detoxified Inpatients with Alcohol Dependence: A Randomized Sham-Controlled Clinical Trial

ABSTRACT Individuals with alcohol dependence often experience cognitive dysfunction after detoxification, which can persist even after sustained abstinence. Transcranial direct current stimulation (tDCS) has shown promise in improving cognitive functioning in these patients. The main objective of this research was to assess the impact of ten sessions of transcranial direct-current stimulation (tDCS) targeting the dorsolateral prefrontal cortex (DLPFC) on the neuropsychological functioning of hospitalized individuals with alcohol dependence who have undergone detoxification. This single-center, parallel, and single-blind randomized controlled trial assessed the effects of ten sessions of add-on tDCS treatment on neuropsychological functions. 44 recently detoxified alcohol-dependent inpatients were randomly assigned to either treatment as usual (TAU) plus ten sessions of active tDCS over left DLPFC, or TAU plus ten sessions of sham tDCS and assessed the effect of tDCS sessions and time on neuropsychological functions. Neuropsychological functions were evaluated in inpatients undergoing treatment for alcohol dependence at T1 (9.95 + 2.42 days abstinence) and T2 (19 ± 1.48 days abstinence), and while time had a significant impact on mean scores of various neuropsychological tests, neither active tDCS treatment nor its interaction with time displayed a significant effect on neuropsychological functioning, as revealed by two-way ANOVAs with repeated measurements. In detoxified inpatients with alcohol dependence, tDCS treatment was not found to have a significant impact on neuropsychological functioning when compared to sham treatment, whereas abstinence from alcohol for approximately three weeks resulted in significant improvements in various cognitive domains including mental speed, verbal learning & memory, visual memory, verbal fluency, and response inhibition.

A Randomized Controlled Single-blind Trial of Transcranial Direct Current Stimulation as Early Augmentation in Major Depressive Disorder: Protocol of a Proof-of-Concept Study

Background: Transcranial direct current stimulation (tDCS) used for augmentation improves depressive symptoms in patients who have a partial or poor response to antidepressant medications. However, its role and effectiveness as an early intervention have not been studied much. This study aims to determine the efficacy and safety of add-on tDCS as an early augmentation strategy in drug-naive patients with major depressive disorder.Methods: A total of 40 patients will be enrolled in the study, randomized into two groups (active and sham), and receive uniform medication Escitalopram 10 mg per day. A total of 10 sessions of tDCS will be given within 2 weeks. Assessments will be done using scales Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D) and Beck’s Depression Inventory (BDI) at baseline, week 2, and week 4 of the study. After each session of tDCS, a side effects checklist will be applied to monitor side effects. The trial has been registered in the Clinical Trials Registry, India(CTRI/2022/01/039123).Result: After data collection, statistical analysis will be done using a computerized statistical program, Statistical Package for Social Sciences. Mean changes in the rating scale scores will be compared after each assessment and between the groups. Conclusion: The findings will help to assess the efficacy of tDCS in the early augmentation of depressive disorder

Superior temporal gyrus functional connectivity predicts transcranial direct current stimulation response in Schizophrenia: A machine learning study.

Transcranial direct current stimulation (tDCS) is a promising adjuvant treatment for persistent auditory verbal hallucinations (AVH) in Schizophrenia (SZ). Nonetheless, there is considerable inter-patient variability in the treatment response of AVH to tDCS in SZ. Machine-learned models have the potential to predict clinical response to tDCS in SZ. This study aims to examine the feasibility of identifying SZ patients with persistent AVH (SZ-AVH) who will respond to tDCS based on resting-state functional connectivity (rs-FC). Thirty-four SZ-AVH patients underwent resting-state functional MRI at baseline followed by add-on, twice-daily, 20-min sessions with tDCS (conventional/high-definition) for 5 days. A machine learning model was developed to identify tDCS treatment responders based on the rs-FC pattern, using the left superior temporal gyrus (LSTG) as the seed region. Functional connectivity between LSTG and brain regions involved in auditory and sensorimotor processing emerged as the important predictors of the tDCS treatment response. L1-regularized logistic regression model had an overall accuracy of 72.5% in classifying responders vs. non-responders. This model outperformed the state-of-the-art convolutional neural networks (CNN) model—both without (59.41%) and with pre-training (68.82%). It also outperformed the L1-logistic regression model trained with baseline demographic features and clinical scores of SZ patients. This study reports the first evidence that rs-fMRI-derived brain connectivity pattern can predict the clinical response of persistent AVH to add-on tDCS in SZ patients with 72.5% accuracy.

Ten Sessions of 30 Min tDCS over 5 Days to Achieve Remission in Depression: A Randomized Pilot Study.

Although transcranial Direct Current stimulation (tDCS) shows promise in the treatment of major depressive episodes, the optimal parameters and population to target remain unclear. We investigated the clinical interest of a 10 session tDCS regimen in patients with mild to severe treatment-resistant depression, in a pilot double-blind, randomized sham-controlled trial. tDCS was delivered over 5 consecutive days (two 30 min sessions per day separated by at least 2 h, 2 mA). The anode and cathode were placed over the left and the right dorsolateral prefrontal cortex, respectively. One month after tDCS, we observed significantly fewer patients who achieved remission (MADRS10 < 10) in the sham group (0 out of 18 patients) than in the active group (5 out of 21 patients; p = 0.05). However, no significant difference was observed between the groups regarding the mean scores of severity changes throughout the study period. Bifrontal add-on tDCS delivered twice per day over 5 days, in combination with antidepressant medication, can be a safe and suitable approach to achieve remission in patients with mild to severe treatment-resistant major depressive disorder. However, in regards to the pilot nature and limitations of the present study, further studies are needed before any frank conclusions can be made regarding the use of tDCS with the proposed parameters in clinical settings.

Feasibility of Combining Transcranial Direct Current Stimulation and Active Fully Embodied Virtual Reality for Visual Height Intolerance: A Double-Blind Randomized Controlled Study.

Background: Transcranial Direct Current Stimulation (tDCS) and Virtual Reality Exposure Therapy (VRET) are individually increasingly used in psychiatric research. Objective/Hypothesis: Our study aimed to investigate the feasibility of combining tDCS and wireless 360° full immersive active and embodied VRET to reduce height-induced anxiety. Methods: We carried out a pilot randomized, double-blind, controlled study associating VRET (two 20 min sessions with a 48 h interval, during which, participants had to cross a plank at rising heights in a building in construction) with online tDCS (targeting the ventromedial prefrontal cortex) in 28 participants. The primary outcomes were the sense of presence level and the tolerability. The secondary outcomes were the anxiety level (Subjective Unit of Discomfort) and the salivary cortisol concentration. Results: We confirmed the feasibility of the association between tDCS and fully embodied VRET associated with a good sense of presence without noticeable adverse effects. In both groups, a significant reduction in the fear of height was observed after two sessions, with only a small effect size of add-on tDCS (0.1) according to the SUD. The variations of cortisol concentration differed in the tDCS and sham groups. Conclusion: Our study confirmed the feasibility of the association between wireless online tDCS and active, fully embodied VRET. The optimal tDCS paradigm remains to be determined in this context to increase effect size and then adequately power future clinical studies assessing synergies between both techniques.

Novel Use of Transcranial Direct Current Stimulation (tDCS) in Adolescents with Early Recovery Stage of Neuroleptic Malignant Syndrome or Catatonia

There are limited options to treat psychotic symptoms during early recovery stage of neuroleptic malignant syndrome (NMS) and catatonic symptoms in adolescents because of restrictions on the use of electroconvulsive therapy (ECT). Add-on transcranial direct current stimulation (tDCS) treatment twice daily for five consecutive days showed improvement in auditory–visual hallucinations and cognitive and bio-social functioning during early recovery stages of NMS in an adolescent. The use of tDCS in another adolescent diagnosed with severe depressive episode with psychotic symptoms and catatonia showed improvement in staring, mutism, rigidity, and interaction with add-on tDCS. The improvement observed lasted for a short duration and tDCS treatment was well tolerated without any severe adverse effect.

S195. ROLE OF BOOSTER SESSION TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) FOR PERSISTENT AUDITORY HALLUCINATIONS IN SCHIZOPHRENIA

BackgroundAuditory verbal hallucinations (AH), one of the hallmark symptoms, are present in 60–80% of schizophrenia (SZ) patients. 25% of patients suffering from AH in schizophrenia fail to respond to any psychotropic medication. Non-invasive brain stimulation techniques like transcranial direct current stimulation (tDCS), with cathodal electrode placement on the left temporoparietal junction (TPJ) is known to alleviate such symptoms in SZ. In this study, we describe the effects of booster tDCS after relapse of AH in patients. The pattern and effectiveness of booster treatment cycles for alleviation of AH in a naturalistic clinical setting are explored in this study.MethodsPatients with persistent AH (n=15) received an initial course (cycle) of add-on tDCS with cathode at left TPJ and anode over left dorsolateral prefrontal cortex (L-DLPFC) with 2mA current, twice-daily 20-minute sessions for 5 days with intersession interval of 3-hours. Clinical global impression- improvement scale (CGI-I) was rated at the end of the course for every patient. All the patients who were found to show response (“much improved” and “very much improved”) received repeat cycles of add-on booster tDCS after a varying duration ranging from 1–32 months from initial treatment course, due to relapse/persistence of AH. Thirteen out of fifteen patients received one booster cycle while one patient received 3 booster cycles and another received 12 booster cycles. We conducted a spearman’s rank correlation test to determine the correlation between CGI-I score rating at the end of add-on tDCS, and the duration of maintenance of improvement before relapse/ worsening of AH.ResultsSix of the fifteen patients (40%) had responded “very much improved” and nine (60%) patients had responded “much improved” to tDCS in the initial cycle. It was found that 50% of the initial “very much improved” responders (n=3) had a comparable response to tDCS after booster sessions for relapse of symptoms while 50% of patients showed “much improved” (n=2) and “minimally improved” (n=1) response in the booster sessions. Among the nine patients who showed “much improved” response from the initial cycle, one patient showed better response than initial cycle (“very much improved”) to booster session. Five patients showed “minimally changed” response in the second cycle in the booster sessions while three patients had comparable responses. The average duration of symptom free interval/ maintenance of improvement with initial cycle of tDCS was found to be 10.46± 9.23 months. The CGI improvement from the initial add-on tDCS course and the duration of the maintenance of improvement/symptom-free interval before the booster session was not found to be significantly correlated (r=0.332, p=0.226)DiscussionA reduction in hallucinations was noted with booster tDCS in patients who had responded to the initial course of add-on tDCS. Booster tDCS is a feasible option and given its cost-effectiveness and ease of administration, booster sessions of tDCS can be considered for resurgence of symptoms. Future studies are recommended in systematically exploring maintenance tDCS as an add-on treatment for persistent/recurring AVH in schizophrenia.

Utility of pre-supplementary motor area anodal high definition transcranial direct current stimulation for treatment resistant obsessive compulsive disorder

Introduction Significant proportion of patients with obsessive compulsive disorder (OCD) continues to be disabled due to inadequate treatment response despite adequate treatment with selective serotonin reuptake inhibitors (SSRIs). The treatment options in such situations are limited and there is a need to evaluate more “neurobiologically informed” treatment approaches in OCD. Earlier studies have reported potential utility of add-on conventional transcranial Direct Current Stimulation (tDCS) in treatment-resistant OCD. Conventional tDCS modulates cortical regions wider than intended. Additionally, the largest cortical current density might not be localised directly beneath the target electrode. These factors may contribute to the inconsistent observations on the effect of add-on tDCS for OCD. High-Definition tDCS (HD-tDCS) is a recent advancement of technique which optimizes the neuromodulation through focalized current application. Aim In this report, we describe the first-time application of add-on HD-tDCS in SSRI-resistant OCD patients. Pre-Supplementary Motor Area (Pre-SMA) the target chosen for anodal stimulation considering its important role in the neurobiological understanding of the disorder. Methods Fourteen patients [Age = 35.9 ± 8.4years; male:female = 11:3]with DSM-V-OCD having persistent symptoms despite adequate and stable treatment with SSRIs were administered HD-tDCS (anodal 2 mA, right Pre-SMA). Two sessions of 20 minutes each per day, scheduled 20 minutes apart were administered for 5 consecutive days. HD-tDCS was administered using standard equipment (Soterix Medical MxN HD system; http://soterixmedical.com/mxn.php ) using stringent safety measures. The MxN HD-tDCS system offers a technical enhancement with optimised electrodes and montage configurations that substantially increase the focality of stimulation. The target of stimulation was ascertained using neuronavigation done after acquiring T1 weighted MRI. Those patients achieving at least 25% reduction in YBOCS total score were categorized as “responders”. At the end of each session, a structured questionnaire was used to assess any potential adverse effect that might have occurred either during or after the HD-tDCS session. Results There was a significant reduction in YBOCS total score after HD-tDCS sessions [Baseline vs. Post HD-tDCS = 27.6 ± 5.7 vs. 19.4 ± 8.0, t = 3.9, P = 0.002]. Mean percentage reduction in YBOCS total score was 29.1 ± 23.6 (median = 25.8) and there were 8 (57.1%) responders. There were no significant adverse effects reported by the patients. Conclusions To the best of our knowledge, this is the first study in OCD examining the feasibility and clinical utility of add-on HD-tDCS over the pre-SMA in a 4 × 1 ring configuration to treat persistent symptoms unresponsive to the conventional pharmacotherapeutic options. In our patients, we observed rapid amelioration of distressing OCD symptoms with add-on HD-tDCS. All sessions were very well tolerated by the patients and they reported no adverse effects either during or after HD-tDCS. Overall, the results from this preliminary open-label observation of HD-tDCS in OCD shows promise for its use in this condition. HD-tDCS may evolve as a treatment option for treatment resistant OCD. Future research is required in this field. Particularly, the efficacy of add-on HD-tDCS in OCD required rigorous evaluation using a randomised, sham-controlled design.

S55. MECHANISTIC BASIS OF FRONTO-TEMPORAL TRANSCRANIAL DIRECT CURRENT STIMULATION ON AUDITORY VERBAL HALLUCINATION IN SCHIZOPHRENIA: A MEDIATION ANALYSIS OF COROLLARY DISCHARGE

BackgroundCorollary discharge (CD), ubiquitous throughout the animal kingdom, refers to suppression of sensory consequences arising from self-generated actions. Complex motor acts like covert/overt speech are associated with corollary discharge that helps in ascertaining agency. Auditory verbal hallucinations (AVH) are hypothesized to originate due to failure of corollary discharge in auditory processing system. Transcranial Direct Current Stimulation (tDCS), as an add-on treatment, has been reported to significantly reduce severity of persistent AVH in schizophrenia patients. In this study, we describe mediation analysis findings that strongly support a role for amelioration of corollary discharge deficits as a mechanistic basis for tDCS effects on AVH in schizophrenia.Methods27 DSM-IV-TR Schizophrenia patients (SCZ) with persistent AVH despite adequate antipsychotic treatment and 27 healthy controls (HC) underwent neurophysiological assessment for CD. In an event-related potential task, N1 component that reflects cortical responsiveness of auditory cortex to sounds, was elicited and examined in two conditions – i) Talk (with online auricular feedback of self-spoken speech sounds) and ii) Listen (passive playback of recorded self-spoken speech sounds). Corollary discharge index (CDI) was calculated by subtracting Listen condition N1 amplitude from Talk condition N1 amplitude (at FCz). Among these 27 patients, 13 patients participated in a randomized, double-blind, sham-controlled study examining the effect of add-on tDCS on AVH and CDI [5 consecutive days, twice-daily, 20-minute sessions; 2mA; anode: left dorsolateral prefrontal cortex; cathode: left temporo-parietal junction]. Mediation analysis was modelled with tDCS type (Verum vs. Sham) as independent variable, percent change in auditory hallucination rating scale score (AHRS) as dependent variable and percent change in CDI as the mediator. As recommended for small samples, bootstrap estimation approach with 5000 samples was used to examine the indirect effect of independent variable on dependent variable through proposed mediator for significance.ResultsSCZ (Mean±SD: -0.67 ± 1.93) had significantly deficient CDI than HC (1.36 ± 2.18) (t=3.62; p=0.001). Verum tDCS (32.24 ± 16.48) resulted in greater percentage reduction in AHRS than sham (4.79 ± 8.84) (t=3.64, p=0.004). There was a significant increase in CDI (t=2.48; p=0.03) with verum (0.85 ± 1.08) but not sham (-0.55 ± 0.98) tDCS. Percent change in CDI positively correlated with percent change in AHRS from pre-RCT to post-RCT time-point for the entire sample (N=13; ρ=0.55, p=0.05). Regression analysis showed that tDCS type (verum/sham) was a significant predictor of percent change in AHRS (β=-27.46, p=0.003) as well as percent change in CDI (β=-1.40, p=0.033). Percent change in CDI was a significant predictor of percent change in AHRS (β=8.87, p=0.014). When controlled for percent change in CDI, tDCS type ceased to be a significant predictor of percent change in AHRS (β=-15.0, p=0.063). The predictors accounted for approximately 75% of the variance (R2=0.756, p<0.001). Bootstrap estimation results indicate the coefficient of indirect effect to be significant, β=-12.46, SE=6.92, 95% CI=-31.20, -2.79, and significantly different from zero at p<0.05 (two tailed).DiscussionFronto-temporal tDCS reduces severity of auditory verbal hallucination in schizophrenia possibly through correction of the deficient corollary discharge. Fronto-temporal network is crucial to self-tagging component of auditory processing and has conspicuous implications for auditory verbal hallucination pathophysiology.Trial No. CTRI/2014/12/005307 (Clinical Trials Registry–India)

Gene polymorphisms and response to transcranial direct current stimulation for auditory verbal hallucinations in schizophrenia.

Recent observations demonstrate a significant ameliorative effect of add-on transcranial direct current stimulation (tDCS) on auditory verbal hallucinations (AVHs) in schizophrenia. Of the many SNPs, NRG1 rs35753505 and catechol-o-methyl transferase (COMT) rs4680 polymorphisms have shown to have a strong association with neuroplasticity effect in schizophrenia. Schizophrenia patients (n=32) with treatment resistant auditory hallucinations were administered with an add-on tDCS. The COMT (rs4680) and NRG1 (rs35753505) genotypes were determined. The COMT genotypes were categorised into Val group (GG; n=15) and Met group (GG/AG; n=17) and NRG1 genotypes were categorised into AA group (n=12) and AG/GG group (n=20). The reduction in auditory hallucination sub-scale score was significantly affected by COMT-GG genotype [Time×COMT interaction: F(1,28)=10.55, p=0.003, ɳ2=0.27]. Further, COMT-GG effect was epistatically influenced by the co-occurrence of NRG1-AA genotype [Time×COMT×NRG1 interaction: F(1,28)=8.09, p=0.008, ɳ2=0.22]. Irrespective of genotype, females showed better tDCS response than males [Time×Sex interaction: F(1,21)=4.67, p=0.04, ɳ2=0.18]. COMT-GG and NRG1-AA genotypes aid the tDCS-induced improvement in AVHs in schizophrenia patients. Our preliminary observations need replication and further systematic research to understand the neuroplastic gene determinants that modulate the effect of tDCS.

Efficacy of fronto-temporal transcranial direct current stimulation for refractory auditory verbal hallucinations in schizophrenia: A randomized, double-blind, sham-controlled study

Persistent auditory verbal hallucinations (AVH) that are refractory to antipsychotic medications are reported in about 20–30% of schizophrenia patients. Transcranial Direct Current Stimulation (tDCS), a non-invasive and safe neuromodulatory technique, has attracted significant interest as an add-on treatment for refractory AVH in schizophrenia. Studies examining the efficacy of tDCS for refractory AVH in schizophrenia have reported inconsistent findings. In this study, using a randomized, double-blind, sham-controlled design (RCT), we sought to examine the effect of add-on tDCS [anode corresponding to left dorsolateral prefrontal cortex and cathode to left temporo-parietal junction; 2-mA, twice-daily sessions for 5-days] to treat refractory AVH in schizophrenia patients (N=25); following this RCT phase, patients that had <30% reduction in AVH severity were offered an open-label extension (OLE) active stimulation to evaluate the effect of cross-over to verum tDCS. In the RCT phase, repeated measures ANOVA with tDCS type [verum (N=12) vs. sham (N=13)] as between subjects factor demonstrated a significant tDCS-type X time-point interaction [F=21.5, p<0.001, partial-η2=0.48] with significantly greater reduction of AVH score in verum tDCS group as compared to sham group. In the OLE phase, sham-to-verum crossed over patients (N=13) showed significantly greater reduction in AVH severity than their corresponding change during RCT phase (t=2.9; p=0.01). Together, these observations add further support to the beneficial effects of add-on tDCS to treat refractory AVH schizophrenia.

Impact of antipsychotic medication on transcranial direct current stimulation (tDCS) effects in schizophrenia patients

Transcranial direct current stimulation (tDCS) has generated interest as a treatment modality for schizophrenia. Dopamine, a critical pathogenetic link in schizophrenia, is also known to influence tDCS effects. We evaluated the influence of antipsychotic drug type (as defined by dopamine D2 receptor affinity) on the impact of tDCS in schizophrenia. DSM-IV-TR-diagnosed schizophrenia patients [N=36] with persistent auditory hallucinations despite adequate antipsychotic treatment were administered add-on tDCS. Patients were divided into three groups based on the antipsychotic’s affinity to D2 receptors. An auditory hallucinations score (AHS) was measured using the auditory hallucinations subscale of the Psychotic Symptom Rating Scales (PSYRATS). Add-on tDCS resulted in a significant reduction inAHS. Antipsychotic drug type had a significant effect on AHS reduction. Patients treated with high affinity antipsychotics showed significantly lesser improvement compared to patients on low affinity antipsychotics or a mixture of the two. Furthermore, a significant sex-by-group interaction occurred; type of medication had an impact on tDCS effects only in women. Improvement differences could be due to the larger availability of the dopamine receptor system in patients taking antipsychotics with low D2 affinity. Sex-specific differences suggest potential estrogen-mediated effects. This study reports a first-time observation on the clinical utility of antipsychotic drug type in predicting tDCS effects in schizophrenia.

TDCS Improves Antisaccade Task Performance in Schizophrenia

s / Brain Stimulation 8 (2015) 360e377 370 Methods: Treatment was applied to a 25-year-old right-handed married woman having schizophrenia (DSM-IV) predominated by auditory verbal hallucinations that were non-responsive to several antipsychotic treatment trials. In August 2013, she was treated with add-on tDCS that led to near total improvement in hallucinations. Over the next one year, she continued to maintain the clinical improvement and was on treatment with Iloperidone 12mg per day. In august 2014, during the 18th week of her first pregnancy, she presented with relapse of auditory hallucinations for a period of one month despite being on regular treatment with Iloperidone. In view of previous clinical benefit, she was treated with add-on tDCS with written informed consent. tDCS was administered using a standard equipment (TCT device model number M101-R-2012-V1.3; prefrontal anode; temporo-parietal cathode; left-sided; 2-mA; 20-minutes; 5-days twice-daily sessions) with stringent safety measures. The severity of auditory hallucinations was measured using the auditory hallucinations subscale (AHS) of PSYRATS. Results: Baseline AHS score was 29. Immediately after 5-days of tDCS, AHS score was 22. Over the period of the next week, the patient reported progressive reduction in hallucinations. AHS score at one month after tDCS was 2. Discussion: This is likely the first report of successful application of tDCS in a pregnant woman with schizophrenia.Rigorous evaluation of add-on tDCS for the treatment of auditory verbal hallucinations in pregnant patients will facilitate establishment of non-invasive and safer alternative to antipsychotic treatment in this special population.

Clinical Utility of Add-On tDCS in Schizophrenia: An Open Label Study of 50 Patients

s / Brain Stimulation 8 (2015) 360e377 370 Methods: Treatment was applied to a 25-year-old right-handed married woman having schizophrenia (DSM-IV) predominated by auditory verbal hallucinations that were non-responsive to several antipsychotic treatment trials. In August 2013, she was treated with add-on tDCS that led to near total improvement in hallucinations. Over the next one year, she continued to maintain the clinical improvement and was on treatment with Iloperidone 12mg per day. In august 2014, during the 18th week of her first pregnancy, she presented with relapse of auditory hallucinations for a period of one month despite being on regular treatment with Iloperidone. In view of previous clinical benefit, she was treated with add-on tDCS with written informed consent. tDCS was administered using a standard equipment (TCT device model number M101-R-2012-V1.3; prefrontal anode; temporo-parietal cathode; left-sided; 2-mA; 20-minutes; 5-days twice-daily sessions) with stringent safety measures. The severity of auditory hallucinations was measured using the auditory hallucinations subscale (AHS) of PSYRATS. Results: Baseline AHS score was 29. Immediately after 5-days of tDCS, AHS score was 22. Over the period of the next week, the patient reported progressive reduction in hallucinations. AHS score at one month after tDCS was 2. Discussion: This is likely the first report of successful application of tDCS in a pregnant woman with schizophrenia.Rigorous evaluation of add-on tDCS for the treatment of auditory verbal hallucinations in pregnant patients will facilitate establishment of non-invasive and safer alternative to antipsychotic treatment in this special population.

Plasticity induced by paired associative stimulation is boosted by concurrently targeting separate motor cortical representations with excitatory and inhibitory protocols

s / Brain Stimulation 8 (2015) 360e377 371 Discussion: This novel observation suggests that PFC stimulation via anodal tDCS may help in correcting deficits in antisaccade task performance. These preliminary findings suggest that enhancement of inhibitory function might be one of the mechanisms underlying the ameliorating effect of add-on tDCS on persistent auditory hallucinations in schizophrenia.

Structural and functional brain alterations induced by a series of prefrontal repetitive transcranial magnetic stimulation

s / Brain Stimulation 8 (2015) 360e377 371 Discussion: This novel observation suggests that PFC stimulation via anodal tDCS may help in correcting deficits in antisaccade task performance. These preliminary findings suggest that enhancement of inhibitory function might be one of the mechanisms underlying the ameliorating effect of add-on tDCS on persistent auditory hallucinations in schizophrenia.

Insight facilitation with add-on tDCS in schizophrenia

Impaired insight in schizophrenia patients has been linked with prefrontal deficits. In this open-label study, we examined for potential insight facilitation effects of add-on tDCS (with anodal stimulation of left DLPFC and cathodal stimulation over left temporo-parietal junction) in schizophrenia patients (N=21) with persistent auditory hallucinations despite adequate antipsychotic treatment. Following tDCS, there was a significant improvement in insight with concurrent significant reduction in auditory hallucination severity. Improvement in insight correlated significantly with improvement in severity of auditory hallucinations. These findings suggest improvement of insight with add-on tDCS in schizophrenia with persistent auditory hallucinations.

P02-555 - Transcranial direct current stimulation (TDCS) of the prefrontal cortex in therapy-resistant depression: A double-blind, placebo-controlled study

BackgroundTDCS for modulating neurophysiology is known since the 1960s. tDCS trials in patients with depression showed promising results.Methods22 patients with therapy resistant major depression (DSM-IV criteria) were included in a four week cross-over trial, 10 received 1 mA tDCS, 12 received 2 mA tDCS, 2 dropped out. Patients received add-on tDCS under a stable antidepressant treatment over 3 weeks and were randomized to active or sham tDCS treatment. The sham condition was evaluated in 10 healthy volunteers and was indistinguishable.Both, active (1 mA resp. 2 mA) and placebo tDCS were applied for 20 min per day and for two weeks and then switched to the other condition. The anode was positioned over F3 and the cathode over the contralateral supraorbital region. For placebo tDCS a novel sham device (neuroConn, llmenau, Germany) was used which is indistinguishable for the applying person. Severity of depression was assessed by HAMD, BDI, CGI and CORE scales and raters were blind to treatment conditions.ResultsMean HAMD decreased by 25% in the whole population after four weeks of tDCS. Active tDCS performed significantly better (p = 0.0492) than the control treatment. However this positive association was restricted to the first study phase as there was also a significant (p = 0.0271) influence of the study phase in the cross-over design and an almost significant (p = 0.0864) interaction between treatment and study phase.ConclusionThough active tDCS was not superior to sham treatment, we observed hangover effects in weeks 3 and 4 depending on the first condition.