Direct Current Stimulation For Treatment Research Articles

Cerebral hemodynamics underlying ankle force sense modulated by high-definition transcranial direct current stimulation.

This study aimed to investigate the effects of high-definition transcranial direct current stimulation on ankle force sense and underlying cerebral hemodynamics. Sixteen healthy adults (8 males and 8 females) were recruited in the study. Each participant received either real or sham high-definition transcranial direct current stimulation interventions in a randomly assigned order on 2 visits. An isokinetic dynamometer was used to assess the force sense of the dominant ankle; while the functional near-infrared spectroscopy was employed to monitor the hemodynamics of the sensorimotor cortex. Two-way analyses of variance with repeated measures and Pearson correlation analyses were performed. The results showed that the absolute error and root mean square error of ankle force sense dropped more after real stimulation than after sham stimulation (dropped by 23.4% vs. 14.9% for absolute error, and 20.0% vs. 10.2% for root mean square error). The supplementary motor area activation significantly increased after real high-definition transcranial direct current stimulation. The decrease in interhemispheric functional connectivity within the Brodmann's areas 6 was significantly correlated with ankle force sense improvement after real high-definition transcranial direct current stimulation. In conclusion, high-definition transcranial direct current stimulation can be used as a potential intervention for improving ankle force sense. Changes in cerebral hemodynamics could be one of the explanations for the energetic effect of high-definition transcranial direct current stimulation.

Effectiveness of Combined Treatment of Transcranial Direct Current Stimulation and Treatment as Usual on Depression, Anxiety and Anger in Adolescents with Bipolar Disorder

Objectives: Bipolar disorder (BD) is a prevalent psychological disorder associated with depressive symptoms. Transcranial direct current stimulation (tDCS) is a portable and non-invasive technique for brain stimulation. The present study was conducted to determine the effectiveness of the combined treatment of tDCS and routine medication on the symptoms of depression, anxiety, and anger in BD adolescents. Methods: In this double-blind randomized clinical trial study, forty adolescents with BD referred to the outpatient clinic of child and psychiatry of Golestan Ahvaz Teaching Hospital were included. Eligible patients aged 12 - 18 years were randomly divided into 2 groups receiving routine medications plus active tDCS (intervention group) or routine medications plus sham tDCS (control group). Transcranial direct current stimulation intervention with an intensity of 2 mA was applied to the dorsolateral prefrontal cortex in two sessions for 20 minutes each day, for 5 consecutive days. Data were collected at baseline, one week, and one month after the start of the intervention using the Hamilton Depression Rating Scale (HDRS-21), Hamilton Anxiety Rating Scale (HDRS), and State-Trait Anger Expression Inventory. Results: Based on our findings, age and gender were not considerably different between the two groups (P = 0.592, P = 0.1, respectively). In both groups, scores of depression (control: 12.25 ± 3.97, intervention: 0.75 ± 1.44, mean [SD]), anxiety (13.55 ± 2.58, 25.0 ± 0.55), and anger (52.65 ± 8.27, 47.25 ± 4.86) improved significantly one month after treatment (P < 0.0001). After one month of treatment, the severity of bipolar symptoms in the intervention group (slightly: 10%, moderately: 50%, and markedly: 40%) improved significantly compared to the control group (slightly: 15%, moderately: 10%, and markedly: 0%) (P < 0.0001). The improvement rate of HDRS in the intervention group was 81.29% and 95.24% at one week and one month after treatment, while these values were 8.41% and 23.04% in the control group, respectively (P < 0.0001). All patients tolerated the treatment well without serious side effects. There was no significant difference between the side effects observed in both groups (P = 0.185). Conclusions: The combination of tDCS with routine medications can reduce depressive symptoms and improve bipolar symptoms. Therefore, tDCS add-on could be an effective, safe, and tolerable intervention for bipolar depression.

Abnormal Structure and Function of Parietal Lobe in Individuals With Attention Deficit Hyperactivity Disorder (ADHD): A Systematic Review Study.

Abnormal brain structure and function have been reported in individuals with attention deficit hyperactivity disorder (ADHD). This study investigated the parietal lobe structure and function alteration in individuals with ADHD. In this systematic review, we searched English papers in accordance with the PRISMA (the preferred reporting items for systematic reviews and meta-analyses) approach. Studies were published between January 2010 and May 2021. Our search was conducted in two parts. Our first search was in July 2020, and our final search was in June 2021. A literature search identified 20 empirical experiments. Functional magnetic resonance imaging (MRI) studies generally reported low activity and poor connectivity; structural MRI studies reported less gray matter in this lobe, and an echo study reported atrophy. In addition, electroencephalographic studies reported less connectivity of the parietal lobes in ADHD. Furthermore, the transcranial direct current stimulation intervention has shown that activation of this lobe improves attention and executive functions in children with ADHD. Finally, a deep transcranial magnetic stimulation study has demonstrated that activation of this lobe improves working memory. Functional and structural alteration of the parietal cortex has been reported in ADHD, which has a causal relationship with cognitive impairments. In sum, all included studies reported abnormal structure, function, or connectivity of the parietal lobe or improvement of cognitive functions with parietal lobe stimulation.

Comparison of the Effectiveness of Mindfulness-Based Stress Reduction Program with Transcranial Direct Current Stimulation on Stress and Rumination in Adolescents with Cancer

Objective: Considering the necessity to identify effective interventions to improve stress and rumination in students, the current study aimed to compare the effectiveness of a mindfulness-based stress reduction program with transcranial direct current stimulation (tDCS) on stress and rumination in adolescents with cancer. Methods and Materials: The research method was a quasi-experimental pre-test and post-test with a control group design. The research population included all adolescents with cancer at Mahak Hospital in Tehran, from which 40 individuals were selected through purposive sampling and randomly assigned to three groups (1- Mindfulness-based stress reduction training; 2- Transcranial direct current stimulation intervention; 3- A combined method of mindfulness-based stress reduction with transcranial direct current stimulation) and one control group. The instruments for data collection included the Lovibond and Lovibond's (1995) Depression, Anxiety, and Stress Scale and the Ruminative Response Scale about an interpersonal upset (2008). For data analysis, one-way analysis of covariance, repeated measures analysis of variance, and the least significant difference post-hoc test were used. Findings: The results of the covariance analysis along with the post-hoc tests showed that there is no significant difference between the mindfulness-based stress reduction method and tDCS in reducing stress levels (P>0.05), and only the difference between these methods compared to the control group was significant (P<0.05). In terms of the effectiveness of the interventions under study on stress levels, the combined method was more effective than using each method separately. Regarding the rumination variable, there was no significant difference between the mindfulness-based stress reduction method and the tDCS method in reducing the level of rumination (P>0.05), and only the difference of this mindfulness method compared to the control group was significant (P<0.05). The results of the repeated measures analysis of variance along with the post-hoc tests indicated that there were no significant differences between the post-test and follow-up stages for stress and rumination variables (P>0.05); hence, the results were stable. Conclusion: Based on the results of the current study, counseling and psychology units established in hospitals and oncology clinics need to be more aware of the mental health of adolescents with cancer and should use the combined method of mindfulness-based stress reduction with tDCS to improve stress and rumination in adolescents with cancer.

Impact of twice-a-day transcranial direct current stimulation intervention on cognitive function and motor cortex plasticity in patients with Alzheimer’s disease

BackgroundNon-invasive brain stimulation has improved cognitive functions in patients with Alzheimer’s disease (AD), and some studies suggest a close relationship between cognition and plasticity. However, the clinical benefits of transcranial...

High-definition Cathodal Direct Current Stimulation for Treatment of Acute Ischemic Stroke

Cathodal transcranial direct current stimulation (C-tDCS) provides neuroprotection in preclinical models of acute ischemic stroke (AIS) by inhibiting peri-infarct excitotoxic effects and enhancing collateral perfusion due to its vasodilatory properties. To report the first-in-human pilot study using individualized high-definition (HD) C-tDCS as a treatment of AIS. This randomized clinical trial was sham controlled with 3 + 3 dose escalation design, and was conducted at a single center from October 2018 to July 2021. Eligible participants were treated for AIS within 24 hours from onset, had imaging evidence of cortical ischemia with salvageable penumbra, and were ineligible for reperfusion therapies. HD C-tDCS electrode montage was selected for each patient to deliver the electric current to the ischemic region only. Patients were followed for 90 days. Primary outcomes were feasibility, assessed as time from randomization to study stimulation initiation; tolerability, assessed by rate of patients completing the full study stimulation period; and safety, assessed by rates of symptomatic intracranial hemorrhage at 24 hours. The efficacy imaging biomarkers of neuroprotection and collateral enhancement were explored. A total of 10 patients with AIS were enrolled, 7 were randomized to active treatment and 3 to sham. Patient age was mean (SD) 75 (10) years old, 6 (60%) were female, and National Institutes of Health Stroke Scale score was mean (SD) 8 (7). Two doses of HD C-tDCS (1 milliamp [mA] for 20 minutes and 2 mA for 20 minutes) were studied. The speed of HD C-tDCS implementation was a median (IQR) 12.5 minutes (9-15 minutes) in the last 4 patients. Patients tolerated the HD C-tDCS with no permanent stimulation cessation. The hypoperfused region was reduced by a median (IQR) 100% (46% to 100%) in the active group vs increased by 325% (112% to 412%) in sham. Change in quantitative relative cerebral blood volume early poststimulation was a median (IQR) 64% (40% to 110%) in active vs -4% (-7% to 1%) sham patients and followed a dose-response pattern. Penumbral salvage in the active C-tDCS group was median (IQR) 66% (29% to 80.5%) vs 0% (IQR 0% to 0%) in sham. In this randomized, first-in-human clinical trial, HD C-tDCS was started efficiently and well tolerated in emergency settings, with signals of beneficial effect upon penumbral salvage. These results support advancing HD C-tDCS to larger trials. ClinicalTrials.gov Identifier: NCT03574038.

Transcranial direct current stimulation alleviates nociceptive behavior in male rats with neuropathic pain by regulating oxidative stress and reducing neuroinflammation.

Transcranial direct curent stimulation (tDCS) and trans-spinal direct current stimulation (tsDCS) are promising therapies for pain that can alter the excitability of neuronal activity in cerebral cortex. The aim of the study is to investigate the therapeutic effects of direct current stimulation (DCS) over the spinal cord and cerebral cortex on oxidative stress and neuroinflammation in rats with chronic constriction injury (CCI).Male Wistar rats were randomly divided into four experimental groups: Sham, CCI, CCI + tDCS and CCI + tsDCS. The neuropathic pain model was induced by using the CCI model. Rats with neuropathy were treated with cathodal tDCS and tsDCS stimulations consisting of 0.5 mA for 30 min a day for 7 days from day 8 onwards. Locomotor activity was measured by open-field test and nociceptive behavior was assessed by hot-plate, tail-flick and Randall-Selitto tests. Following the behavioral experiments, total oxidant capacity (TOC), total antioxidant capacity (TAC) and proinflammatory cytokine levels were evaluated in spinal cord and cerebral cortex tissues. The CCI model induced significant mechanical and thermal hyperalgesia. Nociceptive behaviors in rats with CCI were reversed by DCS treatment. Higher TOC and lower TAC levels were detected in the spinal cord and cerebral cortex tissues of the CCI rats compared to the control. tsDCS treatment amended oxidant/antioxidant status. Moreover, tsDCS modulated the central levels of Tumor necrosis factor-α (TNF-α), interleukin 1-beta (IL-1β), IL-6 and IL-18. tsDCS stimulation showed better therapeutic effect on neuropathic pain by regulating oxidant/antioxidant levels and reducing neuroinflammation. DCS, especially at spinal level, may be a promising therapeutic strategy that can be used alone or in combination with other effective treatments for alleviating neuropathic pain.

Delivery of an at-home transcranial direct current stimulation intervention to mitigate pain in patients with end-stage kidney disease receiving hemodialysis (ESKD/HD).

Poorly controlled pain remains a problem for many patients with end-stage kidney disease requiring hemodialysis (ESKD/HD) and customary approaches to pain management (e.g., opioids, non-steroidals) confer substantial risk. Accordingly, non-pharmacologic therapies are needed for use in this population. Non-invasive transcranial Direct Current Simulation (tDCS) constitutes a promising nonpharmacologic method for pain management in affected individuals. This study seeks to: 1) determine the effects of an 8-week course of at-home tDCS vs. sham tDCS on pain intensity, pain interference, medication usage, quality of life, and mood; 2) determine if tDCS effects vary by race/ethnicity; and 3) ascertain patient satisfaction with device use. This double-blind, randomized, sham-controlled clinical trial will enroll 100 ESKD/HD patients with moderate-to-severe (≥4 on 0-10 scale) chronic pain. The active study intervention consists of 20 min of tDCS delivered over the primary motor cortex 5 days/week for 8 weeks. The comparator is a sham procedure that provides no effective stimulation. The primary outcome analysis will evaluate efficacy of tDCS for pain reduction after two months of stimulation. We will also assess the effects of treatment on analgesic consumption, pain interference, depressed mood, and quality of life. The statistical plan will include fixed classification factors for treatment (vs. sham), clinic sites, and assessment time, and the interaction of these factors adjusting for covariates (e.g., race/ethnicity, pain level). At-home tDCS constitutes a promising nonpharmacologic treatment for pain mitigation in persons with ESKD/HD. This unique RCT could transform the way pain is managed in this vulnerable population. NCT05311956.

Clinical utility of transcranial direct current stimulation for treatment of binge eating disorder with depression: a caser report.

Clinical utility of transcranial direct current stimulation for treatment of binge eating disorder with depression: a caser report.

Efficacy of Intermittent Theta-Burst Stimulation and Transcranial Direct Current Stimulation in Treatment of Post-Stroke Cognitive Impairment.

The efficacy of intermittent theta-burst stimulation (iTBS) and transcranial direct current stimulation (tDCS) combined with cognitive training in the treatment of post-stroke cognitive impairment (PSCI) requires further investigation. We randomly assigned 60 patients with PSCI to receive iTBS (n = 21), tDCS (n = 19), or cognitive training alone (n = 20). Cognitive function was evaluated by the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), and the performance of activities of daily living (ADL) was assessed with the modified Barthel Index (MBI). Of these patients, 14 participated in the functional near-infrared spectroscopy (fNIRS) measurement. After six weeks of treatment, cognitive function improved in all three groups of PSCI patients. Compared with patients receiving only cognitive training, the cognitive function of patients in the iTBS combined with cognitive training (p = 0.003) and tDCS combined with cognitive training groups (p = 0.006) showed greater improvement. The cognitive improvement from tDCS was related to the activation of the frontopolar cortex (FPC), while the improvement of cognition by iTBS was based on the activation of the stimulation site (the dorsolateral prefrontal cortex) and some distant regions. Both iTBS and tDCS in addition to cognitive training appear to improve cognitive function and quality of life of patients with PSCI, compared to cognitive training alone. tDCS improved cognitive function by improving the patient's valuation, motivation, and decision-making substructures, while iTBS improved patients' assessment and decision-making abilities, improving cognitive control and, ultimately, overall cognitive function.

Transcranial Direct Current Stimulation in Treatment of Child Neuropsychiatric Disorders: Ethical Considerations.

Transcranial direct current stimulation (tDCS) is a noninvasive electrical stimulation performed using low electric currents passing through two electrodes. The provided current passes from the anode to the cathode and induces electric fields in the surface neurons. It then modulates synaptic plasticity and finally changes cortical excitability or improves clinical outcomes, which outlast after a duration of stimulation. Meta-analyses have supported the beneficial effects of tDCS treatments in child neuropsychiatric disorders. However, the study of vulnerable children remains controversial and is a great deal for ethical considerations. Because the developing brain has some important physiological differences from the matured brain, specifically less γ-aminobutyric acid (GABA)ergic inhibition and more myelination, the opportunity to modify neurological disorders to be close to the normal level in childhood after tDCS is likely to be higher than in adults. In contrast, these physiological differences may result in unexpected excitability in children's brains and were criticized to have an unsafe effect, specifically seizures, which is a serious adverse events. As mentioned above, using tDCS in children appears to be a double-edged sword and should be ethically considered prior to wide use. Assessing between benefits of tDCS treatment within the golden period of brain development and the risk of seizure provocation is important. Thus, this perspective article is aimed to exhibit broad concepts about the developing brain, tDCS in children, pathophysiology of neuropsychiatric disorders and tDCS beneficence, tDCS safety and tolerability in children, and missing good opportunities or taking risks in tDCS.

Transcranial Direct Current Stimulation in the Treatment of Post-Laminectomy Syndrome: A Clinical Trial

AimsTo evaluate the effectiveness of Transcranial Direct Current Stimulation (tDCS) in treatment of post-laminectomy syndrome.MethodsTwenty-four patients were randomized in three groups to receive active or sham anodic stimulation (1.5 mA, 20 minutes for five consecutive days, with 25cm2 electrodes) in two different areas (primary motor cortex (M1) vs. dorsolateral prefrontal cortex (DLPFC), according to lateralization of pain. Brief Pain Inventory (BPI) and Visual Analogue Scale (VAS) were instruments used to assess pain, while Clinical Global Impression Scale (CGI) was applied to measure severity disease and clinical response. Additionally, the quality of life assessment was based on World Health Organization Quality-of-Life Scale (WHOQOL-BREF). In order to identify psychiatric comorbidities, Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) tests were applied. Comparisons between groups were performed using one-way ANOVA, ANOVA-Welch, Kruskal-Wallis, Man-Whitney, and Fisher's test.ResultsIt is observed that there was a statistically significant difference (difference 0,15† [95% CI, 7,07 ± 1,39]) in the way individuals assess their quality of life and the improvement in pain intensity by VAS, especially in M1. The assessment of quality of life among those who showed improvement was higher than those who did not improved.ConclusionApplication of tDCS in primary motor cortex (M1) produced an improvement in pain pattern in patients with post-laminectomy syndrome. Our data suggest that tDCS - a low-cost, technically simple and highly tolerable technique, is a promising technique for management chronic pain in disorders such as post-laminectomy syndrome.

Efeitos da etcc sobre o aprendizado motor em pessoas com doença de Parkinson / Effects of cts on motor learning in people with parkinson's disease

ASCHERIO, Alberto; SCHWARZSCHILD, Michael A. The epidemiology of Parkinson's disease: risk factors and prevention. The Lancet Neurology, v. 15, n. 12, p. 1257-1272, 2016. BENNINGER, David H.; HALLETT, Mark. Non-invasive brain stimulation for Parkinson’s disease: current concepts and outlook 2015. NeuroRehabilitation, v. 37, n. 1, p. 11-24,2015. BRUNONI, Andre Russowsky et al. A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. International Journal of Neuropsychopharmacology, v. 14, n. 8, p. 1133-1145, 2011. CACABELOS, Ramón. Parkinson’s disease: from pathogenesis to pharmacogenomics.International journal of molecular sciences, v. 18, n. 3, p. 551, 2017. CHEN, Kai‐Hsiang Stanley; CHEN, Robert. Invasive and non‐invasive brain stimulation in Parkinson's disease: Clinical effects and future perspectives. Clinical Pharmacology & Therapeutics, 2019. CHRISTOVA, Monica; RAFOLT, Dietmar; GALLASCH, Eugen. Cumulative effects of anodal and priming cathodal tDCS on pegboard test performance and motor cortical excitability. Behavioural brain research, v. 287, p. 27-33, 2015. FOX, Susan H. et al. International Parkinson and movement disorder society evidence‐based medicine review: Update on treatments for the motor symptoms of Parkinson's disease.Movement Disorders, v. 33, n. 8, p. 1248-1266, 2018. FREGNI, Felipe et al. Noninvasive cortical stimulation with transcranial direct current stimulation in Parkinson's disease. Movement disorders, v. 21, n. 10, p. 1693-1702, 2006. GRÜNER, Ulrike et al. 1 Hz rTMS preconditioned by tDCS over the primary motor cortex in Parkinson’s disease: effects on bradykinesia of arm and hand. Journal of neural transmission, v. 117, n. 2, p. 207-216, 2010. HAYES, Michael W. et al. Updates and advances in the treatment of Parkinson disease. The Medical journal of Australia, 2019. HUANG, Sheau-Ling et al. Minimal detectable change of the timed “up & go” test and the dynamic gait index in people with Parkinson disease. Physical Therapy, v. 91, n. 1, p. 114- 121, 2011. JONES, Sarah E. et al. The five-repetition sit-to-stand test as a functional outcome measure in COPD. Thorax, p. 203- 576, 2013. LANG, Nicolas et al. Preconditioning with transcranial direct current stimulation sensitizes the motor cortex to rapid-rate transcranial magnetic stimulation and controls the direction of after- effects. Biological psychiatry, v. 56, n. 9, p. 634-639, 2004.LEE, Hyo Keun et al. Does transcranial direct current stimulation improve functional locomotion in people with Parkinson’s disease? A systematic review and meta-analysis. Journal of Neuroengineering and rehabilitation, v.16, n.1, p.84-96, 2019. LEFAUCHEUR, Jean-Pascal et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clinical Neurophysiology, v. 128, n. 1, p. 56- 92, 2017. PAPEN, Mitra Von et al. The effects of 1 Hz rTMS preconditioned by tDCS on gait kinematics in Parkinson’s disease. Journal of Neural Transmission, v. 121, n. 7, p. 743-754, 2014. SCHNEIDER, Ruth B.; IOURINETS, Julia; RICHARD, Irene H. Parkinson's disease psychosis: presentation, diagnosis and management. Neurodegenerative disease management, v. 7, n. 6, p. 365-376, 2017. OPARA, Józef et al. Motor assessment in Parkinsons disease. Ann Agric Environ Med, v. 24, n. 3, p. 411-415, 2017. PETERS, Denise M.; FRITZ, Stacy L.; KROTISH, Debra E. Assessing the reliability and validity of a shorter walk test compared with the 10-Meter Walk Test for measurements of gait speed in healthy, older adults. Journal of geriatric physical therapy, v. 36, n. 1, p. 24-30, 2013. REICH, S.G., SAVITT, J.M. Parkinson's Disease. MedIcal Clinics of North America. v. 103 n. 2, p. 337-350, 2018. RIBEIRO, Adriana Costa et al. Dopamine-independent effects of combining transcranial direct current stimulation with cued gait training on cortical excitability and functional mobility in Parkinson's disease. Journal of rehabilitation medicine, v. 48, n. 9, p. 819-823, 2016. RIBEIRO, Adriana Costa et al. Transcranial direct current stimulation associated with gait training in Parkinson’s disease: a pilot randomized clinical trial. Developmental neurorehabilitation, v. 20, n. 3, p. 121-128, 2017. TYSNES, Ole-Bjørn; STORSTEIN, Anette. Epidemiology of Parkinson’s disease. Journal of Neural Transmission, v. 124, n. 8, p. 901-905, 2017. VALENTINO, Francesca et al. Transcranial direct current stimulation for treatment of freezing of gait: A cross‐over study. Movement Disorders, v. 29, n. 8, p. 1064-1069, 2014.

The effectiveness of Transcranial Direct Current Stimulation on Cognitive and Executive Function in Children with Language Impairment

Background: Existence of a language disorder can directly affect various aspects of social life of children. This study aimed to examining effectiveness of tDCS on cognitive and executive functions in children with language impairment. Materials and Methods: The present study is quasi-experimental with a pretest-posttest design and a control group. Twenty-four children with language impairment were selected from 1st to 3rd grade elementary school students in Gorgan. In pre-test, participants performed a simple selective and divided attention test and an overarm throwing test including 10 throws. After pre-test, participants were randomly divided into experimental and control groups (each 12 participants). Participants in experimental group underwent transcranial direct current stimulation intervention for one-day interval of three sessions. Anodal electrode was placed on the left dorsolateral prefrontal cortex and the cathodal electrode on the participant’s right shoulder. The duration of stimulation in each session was 20 minutes, and the intensity of stimulation was 1.5 mA. Control group performed no particular intervention. Following intervention, post-test was performed. Results:The mean age of participants was 7.78 years; the mean weight was 34.33 kg and the mean height was 131.29 cm. The results showed in terms of simple selective (p=0.001) and divided (p=0.011) attention and overarm throwing (p=0.001), there was a significant difference between the experimental and control groups, and the function of the experimental group was better than the control group due to different averages. Conclusions:In general, it can be stated that the use of tDCS intervention in three sessions of 20 minutes with an intensity of 1.5 mA can improve cognitive and executive functions in children with language disorders.

Transcranial direct current stimulation in treatment of tinnitus

Background and Aim: Approximately 20% of general population is struggling with tinnitus. Recent theories on tinnitus are mainly based on impairments in the central auditory system that can lead to tinnitus. Recent studies have shown that tinnitus is not simply a result of the involvement of one brain region or pathway; but it can be caused by simultaneous involvement of multiple brain regions. Due to lack of information about the tinnitus etiology, site, and pathophysiology, there is still no any specific and common method for its management. In recent years, neuromodulation techniques such as transcranial direct current stimulation (tDCS) has been proposed for management of tinnitus. In this study, we aimed to review the role of tDCS in tinnitus management. Recent Findings: Based on the inclusion criteria, 7 eligible articles were selected for review. Most of them showed the beneficial effects of tDCS on tinnitus management. Conclusion: The tDCS can be an effective technique for management of tinnitus. One of the main challenges for using tDCS in tinnitus patients is the differnce in stimulation parameters; therefore, more studies are recommended for obtaining its ideal parameters. Recent Findings: Based on the inclusion criteria, 7 eligible articles were selected for review. Most of them showed the beneficial effects of tDCS on tinnitus management. Conclusion: The tDCS can be an effective technique for management of tinnitus. One of the main challenges for using tDCS in tinnitus patients is the differnce in stimulation parameters; therefore, more studies are recommended for obtaining its ideal parameters. Keywords: Transcranial direct current stimulation; tinnitus; neuromodulation

Effect of combined yoga and transcranial direct current stimulation intervention on working memory and mindfulness.

Transcranial direct stimulation, a non-invasive neurostimulation technique for modulating cortical excitability, and yoga have both respectively been shown to positively affect cognition. While preliminary research has shown that combined transcranial direct stimulation and meditation may have synergistic effects on mood and cognition, this was the first study to explore the combination of transcranial direct stimulation and yoga. Twenty-two healthy volunteers with a regular yoga practice were randomized to receive either active transcranial direct stimulation (anodal left, cathodal right dorsolateral prefrontal cortex) followed by yoga intervention or sham transcranial direct stimulation followed by yoga intervention a double-blind, cross-over design over two separate intervention days. Outcome measures included working memory performance, measured with the n-back task and mindfulness state, measured with the Toronto Mindfulness Scale, and were conducted offline, with pre-post assessments. Twenty participants completed both days of the intervention. Active transcranial direct stimulation did not have a significant effect on working memory or levels of mindfulness. There was a significant placebo effect, with better performance on day 1 of the intervention, irrespective of whether participants received active or sham transcranial direct stimulation. There was no significant difference between active versus sham transcranial direct stimulation concerning working memory performance and mindfulness, which may be accounted by the small sample size, the transient nature of the intervention, the fact that yoga and transcranial direct stimulation concerning were not conducted simultaneously, and the specific site of stimulation.

Effects of transcranial direct current stimulation combined with cognitive orientation to daily occupational performance in children with cerebral palsy: a protocol for a randomised controlled trial

Background/Aims Children with hemiplegic cerebral palsy have limitations in activities requiring reach and manipulation of objects with their affected upper extremity. Transcranial direct current stimulation and the cognitive orientation to occupational performance approach are relatively new interventions that may lead to promising results for these children. This article describes the method of a randomised clinical trial that will compare the effects of the combination of transcranial direct current stimulation and cognitive orientation to daily occupational performance with transcranial direct current stimulation and neurodevelopmental treatment. Methods A four-armed clinical trial with a sample size of 36 participants will be performed in Tehran. Participants will be randomly divided into four groups. Group A will receive neuro-developmental treatment with sham transcranial direct current stimulation, group B will receive neurodevelopmental treatment with transcranial direct current stimulation, group C will receive cognitive orientation to daily occupational performance with sham transcranial direct current stimulation, and group D will receive cognitive orientation to daily occupational performance with transcranial direct current stimulation. The examiner will be blind to the study and assessments will be done at baseline, after the end of the intervention and 1 month after the completion of the intervention (as follow up). Data analysis will be as repeated measure analysis of variance and intention to treat. Conclusions This article describes the protocol of a clinical trial that compares the effects of the combination of transcranial direct current stimulation and cognitive orientation to daily occupational performance with the combination of transcranial direct current stimulation and neurodevelopmental treatment on upper extremity goals and functions of children with hemiplegic cerebral palsy.

Effects of add-on transcranial direct current stimulation on pain in Korean patients with fibromyalgia

Despite promising preliminary results of transcranial direct current stimulation (tDCS) treatment in patients with fibromyalgia (FM), several issues need to be addressed, including its limited efficacy, low response rate, and poor tolerability. We investigated the efficacy and safety of tDCS as an add-on treatment for chronic pain in Korean patients with FM. This study enrolled 46 patients who were refractory to pain medications from May 2016 to February 2017. A conventional tDCS device was used to supply 2 mA of current for 20 min on five consecutive days. The primary end-point was a change in visual analogue scale (VAS) pain score at the end of treatment; secondary end-points included changes in Fibromyalgia Impact Questionnaire (FIQ), Brief Pain Inventory (BPI), Brief Fatigue Inventory (BFI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Medical Outcomes Study Sleep Scale (MOS-SS) scores. After tDCS, 46 patients showed clinical improvements in VAS pain scores on days 6, 13, and 36 compared with day 0 (p < 0.001). Improvement in FIQ was seen on day 13. The BDI decreased significantly on days 6 and 36, and BFI improved significantly on days 6 and 13. There were no significant improvements in STAI-I, STAI-II, and MOS-SS scores after tDCS. No serious adverse events were observed. Our results suggest that tDCS can result in significant pain relief in FM patients and may be an effective add-on treatment.

T188. THE CLINICAL SCIENCE OF TRANSCRANIAL DIRECT CURRENT STIMULATION STUDIES IN SCHIZOPHRENIA: SYSTEMATIC REVIEW AND META-ANALYSIS

BackgroundTranscranial direct current stimulation interventions have produced findings that inform clinical neuroscience, and may have potential as a treatment for the cognitive symptoms of schizophrenia-spectrum illnesses. The first recorded study of tDCS in this population was in 1994 and every year since then has seen growth in the number of studies conducted, with 15+ studies each year since 2013. This project is a meta-analysis of studies using transcranial direct current stimulation in people with schizophrenia-spectrum illnesses and any domain of cognition.MethodsSearch terms sought out articles in populations with schizophrenia, schizoaffective, schizotypal, schizoid, unspecified psychosis, and thought disorder illnesses. Within these populations, non-invasive electrical stimulation terms included transcranial direct current stimulation, tDCS, and transcranial electrical stimulation. Within those studies, cognitive terms included working memory, memory, cognitive control, executive function, attention, recall, recognition, perception, learning, cognition, inhibition, and executive control. PRISMA guidelines were followed.Results177 Articles were located through a literature search using the PubMed database. 39 studies were screened out by title, 102 studies were screened out by abstract, 7 studies were screened out by text. Finally, 29 studies were subjected to meta-analysis.DiscussionWhile the research on transcranial direct current stimulation continues to develop, the current study highlights methodological trends like studies with stimulation concurrent to task and those using training approaches. Overall effects are summarized by defining study characteristics and cognitive domains, where appropriate.

Preliminary Results of a Transcranial Direct Current Stimulation Intervention in Military Patients With Posttraumatic Stress Disorder, Anxiety and Aggression

Preliminary Results of a Transcranial Direct Current Stimulation Intervention in Military Patients With Posttraumatic Stress Disorder, Anxiety and Aggression