Sham tDCS Research Articles

Telehealth tDCS to reduce cannabis use: A pilot RCT in multiple sclerosis as a framework for generalized use.

Cannabis use is rising in the United States. Up to 30 % of individuals who use cannabis develop cannabis use disorder (CUD), for which there are no FDA-approved treatments. This randomized controlled trial (RCT) evaluated the feasibility and efficacy of a novel, one-month telehealth intervention of remotely supervised tDCS (RS-tDCS) paired with mindfulness meditation. This home-based telehealth intervention was evaluated in a cohort of women with multiple sclerosis (MS), a vulnerable subpopulation of adults with high rates of CUD. The intervention included 20 home-based RS-tDCS sessions targeting the left DLPFC, delivering 2.0mA for 20minutes, paired with guided mindfulness meditation. Sessions were conducted 5 days per week for four weeks. Fifty-two women with MS and CUD (age: 44 ± 10 years) consented to participate; 47 were randomized 2:1 to active or sham tDCS. Feasibility was assessed via retention and adherence, while preliminary efficacy was measured by cannabis use, withdrawal symptoms, and MS-related symptom scales. Of 47 randomized participants (31 active, 16 sham), 39 (83 %) completed the intervention. The active tDCS group showed significant reductions in weekly cannabis use (Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory, DFAQ-CU: 5.3 ± 2.4 vs. 3.9 ± 2.7 days, p = 0.014) and withdrawal symptoms (CWS: p < 0.001). A trend toward reduced MS-related symptoms was observed (SymptoMScreen: p = 0.031). Cognitive performance improvement at the end of the intervention was significant in the active group (p = 0.011 vs. p = 0.172), supporting functional benefits of reduced cannabis use. This pilot RCT supports the feasibility and preliminary efficacy of telehealth tDCS in a medical subpopulation. Studying women with MS highlights its potential for large-scale RCTs and clinical use.

Transcranial direct current stimulation combined with motor training for motor symptoms in Parkinson's disease: A systematic review and meta-analysis.

Transcranial direct current stimulation combined with motor training for motor symptoms in Parkinson's disease: A systematic review and meta-analysis.

Pilates and Transcranial Direct Current Stimulation for Stability, Balance, and Depression in Patients with Stroke

This study aimed to investigate the effects of combining Pilates and transcranial direct current stimulation (tDCS) on core stability, balance, and depression in stroke patients. Forty subjects were randomly divided into an experimental group (n = 20) and a control group (n = 20). The experimental group received 20 min of tDCS followed by 30 min of Pilates exercises, while the control group underwent sham tDCS with the same Pilates regimen. Both groups followed the intervention schedule twice a week for 4 weeks. Core stability, static balance, and dynamic balance were assessed using the pressure biofeedback stabilizer (PBS), functional reach test (FRT), and timed up and go (TUG) test. Depression levels were evaluated using the short form geriatric depression scale–Korean version (SGDS-K). Both groups showed significant improvements in core stability, balance, and depression (p < 0.001) after the intervention, but the experimental group demonstrated significantly greater gains compared to the control group (p < 0.05). The results suggest that the combined treatment of Pilates and tDCS offers superior benefits over Pilates alone in improving physical and emotional outcomes in stroke patients. Incorporating tDCS into rehabilitation programs could enhance recovery and quality of life for stroke survivors.

Enhancing Goal Achievement in Adults With ADHD: A Participant-Centered Evaluation of Transcranial Direct Current Stimulation From the TUNED Trial.

Few trials in ADHD incorporate participant-centered outcomes that evaluate the impact of interventions on meaningful life activities. Additionally, in psychiatry, the translation of changes in symptom rating scales into meaningful impacts on participants' lives has been questioned. The Transcranial Direct Current Stimulation (tDCS) for the Treatment of Inattention Symptoms in Adult Patients with ADHD (TUNED) trial demonstrated improved inattention symptoms, assessed using a clinician-administrated scale, after a 4-week treatment with daily home-based tDCS in adults with ADHD. Here, our primary objective was to evaluate the impact of tDCS in ADHD using a participant-centered and clinically relevant outcome. We analyzed data from the TUNED trial (ClinicalTrials.gov Identifier: NCT04003740), a randomized, double-blind, parallel, sham-controlled study testing tDCS in adults with ADHD. At the baseline assessment, all participants were instructed to select up to three goals they desired to achieve during the trial period. The goals had to be specific, measurable, achievable, relevant, and time-bound. Our main outcome was the number of goals achieved at the end of the intervention. Of the 64 participants randomized, 55 completed the trial and were included in the analyses (26 [47%] inattentive presentation and 29 [53%] combined presentation; mean (SD) age, 38.1 [9.8] years; 40% women). In the active tDCS group (n = 25), eight participants (32%) achieved one goal, 5 (20%) achieved two goals, 3 (12%) achieved all three goals, and 9 (36%) achieved no goals. In the sham tDCS group (n = 30), 3 (10%) participants achieved one goal, 3 (10%) achieved two goals, 3 (10%) achieved all three goals, and 21 (70%) achieved no goals. Ordinal logistic regression analyses showed that participants in the active tDCS group were more likely to achieve a higher number of goals compared to those in the tDCS sham group (OR = 3.05, 95% CI [1.06, 8.75], p = .03]). This study demonstrated that tDCS can significantly enhance the ability to achieve personal goals in adults with ADHD. By using a participant-centered approach, our findings not only support tDCS as a promising treatment for ADHD but also align with the growing emphasis on personalized medicine and clinically relevant, participant-reported outcomes in clinical research.

Modulation of pain sensitivity by tDCS using different anodal connector locations: a single-blinded, randomized, sham-controlled study.

The efficacy of transcranial direct current stimulation (tDCS) depends on various stimulation parameters. With rectangular electrodes, the location of the wire connector may affect the electrical field relative to the underlying target area. Here, we examined longitudinal changes in pain sensitivity and GABA levels in response to tDCS using standard rectangular (5 × 7 cm) electrodes and two different anodal connector locations. In this single-blinded, randomized, sham-controlled study, 53 healthy volunteers were assigned to one of 4 groups, receiving either real tDCS or sham tDCS, with the anodal connector oriented either superior-medially or ventral-laterally. tDCS was delivered on 5 consecutive days with the anode and cathode placed over the left primary sensorimotor cortex (SM1) and the right dorsolateral prefrontal cortex, respectively. Pain detection thresholds (PT) and moderate pain thresholds (MPT) of the right index finger and GABA levels from the bilateral SM1 were obtained prior to tDCS, after 5 tDCS sessions, and after 6 weeks. Superior-medial oriented tDCS significantly increased both pain thresholds at day 5 and at 6 weeks, whereas ventral-lateral oriented tDCS or sham tDCS did not. At day 5, MPT was significantly increased when comparing superior-medial oriented tDCS with sham tDCS. At week 6, both thresholds were significantly increased when comparing superior-medial oriented tDCS with ventral-lateral oriented tDCS and MPT was also increased when comparing superior-medial oriented tDCS with sham tDCS. GABA levels did not differ between time-points or between groups and no association was found between baseline GABA levels in the stimulated hemisphere and change in pain thresholds. tDCS-induced long-lasting changes in pain sensitivity may depend on the location of the wire connector when using a rectangular anode. A greater pain modulatory effect may be induced when the connector is aligned superior-medially along the central sulcus.

Effect of transcranial direct current electric stimulation associated with physical exercise in patients with greater trochanteric pain syndrome

Objective: To describe a protocol for a trial evaluating the effects of physical exercise combined with transcranial direct current stimulation (tDCS) on greater trochanteric pain syndrome (GTPS), and to report the results from the feasibility phase. Design: Adults with GTPS will be recruited for this randomized controlled trial. Participants will be allocated to receive either tDCS combined with resistance training or exercise alone (sham tDCS). The primary outcome is pain, assessed using the Victorian Institute of Sports Assessment for Gluteal Tendinopathy on day 30. Secondary outcomes include performance on the Copenhagen Hip and Groin Outcome Score (HAGOS), Pain Quality Assessment Scale, 36-Item Short Form Survey, and McGill Pain Questionnaire (MPQ), evaluated immediately after the intervention and at 30 and 60 days post-protocol. The feasibility phase followed the same protocol. Results: In the feasibility phase, no participants reported significant side effects. Improvements were observed in 36-Item Short Form Survey, Victorian Institute of Sports Assessment for Gluteal Tendinopathy, HAGOS, and MPQ scores, except in the miscellaneous component of the MPQ and the “participation in physical activities” domain of the HAGOS. Conversely, no changes were noted in Pain Quality Assessment Scale scores. Conclusion: The results suggest that conducting a trial involving tDCS combined with low-intensity resistance training for GTPS is feasible.

Home-Based Transcranial Direct Current Stimulation vs Placebo for Fibromyalgia

Previous trials with smaller samples and shorter follow-up periods showed that multiple-session home-based anodal transcranial direct current stimulation (A-tDCS) on the left dorsolateral prefrontal cortex (DLPFC) improved fibromyalgia symptoms. However, the duration of the effect, the influence of exercise and pain neuroscience education (PNE), and the role of placebo remain unclear. To evaluate whether A-tDCS targeting the left DLPFC, combined with exercise and PNE, is more effective than sham tDCS in reducing pain and disability, based on placebo-test responses (responders vs nonresponders). This double-blind, sham-controlled randomized clinical trial enrolled women aged 18 to 65 years with fibromyalgia. Participants were randomized to receive A-tDCS or sham tDCS between April 2022 and April 2024. They were treated at home and at the outpatient Clinical Research Center of Hospital de Clínicas de Porto Alegre in Porto Alegre, Brazil. Exclusion criteria included tDCS contraindications and uncontrolled clinical conditions. Intention-to-treat analyses were conducted from July to December 2024. Home-based tDCS (2 mA; 20 minutes daily) or sham tDCS (2 mA; 30 seconds at the start, then 10 minutes, and then 20 minutes, with a 20-second ramp-up and ramp-down) for 4 weeks with anodal-left and cathodal-right prefrontal stimulation (35 cm2 electrodes), combined with exercise and PNE via videos and remote supervision following in-person training. Change in Multidimensional Pain Interference Index (MPII) at treatment end and 3-month follow-up. MPII was measured by the Brief Pain Inventory, a 7-item scale that assesses the impact of pain on daily activities, emotional well-being, and social interactions. A total of 112 female patients (mean [SD] age, 49.04 [9.71] years) were included and randomized to either A-tDCS (n = 56 placebo nonresponders) or sham tDCS (n = 56 placebo responders). In the intention-to-treat analysis, linear mixed-effects models showed reduced MPII by 38.76% (95% CI, -41.90% to -30.92%) for the A-tDCS group vs 16.08% (95% CI, -21.42% to -10.41%) for sham tDCS (mean difference [MD], 22.68%; 95% CI, 12.79%-40.00%; Cohen d = 0.73). A significant treatment-by-time interaction favored A-tDCS across 5 assessments, with no interaction by placebo response. In placebo responders, MPII was reduced by 34.21% (95% CI, -46.88% to -28.29%) for A-tDCS vs 18.13% (95% CI, -24.90% to 3.34%) for sham tDCS (MD, 24.23%; 95% CI, 15.80%-32.67%). Among placebo nonresponders, MPII decreases were 35.49% (95% CI, -41.21% to -29.53%) for A-tDCS vs 25.96% (95% CI, -34.31% to -20.42%) for sham tDCS (MD, 9.52%; 95% CI, 2.79%-19.78%). Improvement in MPII of 50% or more was achieved by 62.5% of participants (n = 35) in the A-tDCS group vs 37.5% (n = 21) in the sham tDCS group (relative risk, 0.60; 95% CI, 0.39-0.91). This trial found that A-tDCS along with exercise and PNE improved disability due to pain, especially in placebo test responders. The findings support fibromyalgia management and enhance understanding of tDCS-related placebo effects. ClinicalTrials.gov Identifier: NCT05845528.

Behavioral and Neural correlates of Post-STROKE Fatigue: A randomized controlled trial protocol

IntroductionPost-stroke fatigue (PSF) is highly prevalent and lacks of effective management. Recent evidence suggest the use of transcranial direct current stimulation (tDCS) to reduce PSF. However, the effect was not lasting and the working mechanisms was unclear. The purpose of this study is to determine the behavioral and neurophysiological effects of five daily sessions of tDCS on PSF.Methods and analysisThis will be a double-blind randomized controlled trial targeting an enrollment of 32 participants with subacute-chronic stroke and significant fatigue (average Fatigue Severity Scale (FSS) > 4). Participants will be equally randomized to either anodal tDCS or sham tDCS groups. The anodal tDCS group will receive 20 minutes of 2-mA anodal tDCS applied to the ipsilesional primary motor cortex (M1) for five consecutive days. The sham tDCS group will receive the same protocol except there will be no active current delivered. Outcome assessments will take place at baseline (prior to randomization), immediately after the intervention, and at one-month follow-up. The primary behavioral outcome will be the FSS and the primary neurophysiological outcome will be an input-output curve of motor cortex excitability derived using transcranial magnetic stimulation. Secondary behavioral outcomes will include Fatigue Scale for Motor and Cognitive Function, Visual Analog Scale-Fatigue, Borg Rating of Perceived Exertion, and Paas Mental Effort Rating Scale. Secondary neurophysiological outcome will be the functional connectivity of the fronto-striato-thalamic network acquired using resting state functional Magnetic Resonance Imaging (MRI). Repeated measure ANOVA or ANCOVA will be conducted for all outcomes to compare the change between groups.DiscussionLittle is known about effective treatments for PSF and the underlying mechanisms of PSF. tDCS is a promising tool to provide targeted intervention to reduce PSF symptoms. However, its lasting effect and working mechanism on PSF is elusive. The results of this clinical trial will offer critical information for PSF management and investigation.Trial registrationThis trial was registered in February 1 2024 with ClinicalTrials.gov under the registration number NCT06088914.

Use of TDCS with proprioceptive exercises to improve gait and balance in visually impaired children and preadolescents: a protocol for randomized clinical trial study.

In the absence of information from the visual system, balance is guided by only two of the three afferent systems. If there is no early stimulation of these systems, blind children tend to become passive, which can have a negative impact on muscle tone, coordination and balance. The aim of the present study protocol is to investigate whether transcranial direct current stimulation (tDCS) can enhance the effects of static and dynamic proprioceptive exercises on gait and balance control in children and preadolescents with acquired or congenital visual impairment. This randomized controlled trial will be conducted in three phases, starting with a cross-sectional analysis, followed by a pilot study, and concluding with a full-scale clinical trial. The study will be conducted following approval from the institutional review board of Universidade Evangélica de Anápolis, Anápolis, GO, Brazil (certificate number:4610052.6.0000.5076). The study will be divided into three phases. Phase 1 will be a cross-sectional study to characterize gait, postural control and balance (static and dynamic) in the sample. Phase 2 will be a pilot study that will serve to determine the sample size in Phase 3. Both phases 2 and 3 will employ the same methods and will constitute a randomized, controlled, double- blind, clinical trial. The participants will be randomly divided into four groups: (G1) active tDCS + static proprioceptive exercises; (G2) sham tDCS + static proprioceptive exercises; (G3) active tDCS + dynamic proprioceptive exercises; (G4) sham tDCS + dynamic proprioceptive exercises. The results will be based on evaluations performed on three occasions [preintervention, postintervention (after ten treatment sessions) and 1-month follow-up] and will involve three-dimensional gait analysis as well as assessments of functional mobility functional and balance (static and dynamic). The expected outcomes of this study protocol include determining the postural differences, functional mobility, and static balance between children and pre-adolescents with congenital and acquired visual impairment and enable the establishment of new rehabilitation protocols.

Multisession transcranial direct current stimulation and aerobic exercise synergistically improve food craving symptoms, impulsivity, and cognitive flexibility in women with overweight and obesity: a randomized controlled trial

BackgroundWe explored the potential synergistic effects of combining multisession anodal transcranial direct current stimulation (a-tDCS) with chronic aerobic exercise (AE) on food cravings (FC), impulsivity (IMP), risky decision-making (RDM), and cognitive flexibility (CF) in women with overweight or obesity exhibiting food craving symptoms.MethodsThirty-six women with overweight or obesity and symptoms of food craving (age: 26±6,4 years) were randomly allocated into three groups using permuted block randomization (n = 12 each): (1) a-tDCS + AE, (2) Sham + AE, and (3) Control (no intervention). During Phase 1, the a-tDCS + AE group received five consecutive sessions of a-tDCS, while the Sham + AE group received sham tDCS. In Phase 2, both the a-tDCS + AE and Sham + AE groups completed three sessions of moderate-intensity continuous aerobic exercise per week for four weeks. Outcome measures, including food cravings (FC) and cognitive flexibility (CF), were assessed at baseline, after five days of tDCS, and after four weeks of AE. Follow-up measurements for FC and CF were also conducted one month post-intervention.ResultsFC was lower in the a-tDCS + AE group compared to Sham + AE and Control groups in Phase 1 (Cohen’s d = 1.4 and 1.9, respectively). In Phase 2, a-tDCS + AE and Sham + AE groups showed lower FC than the Control group (d = 3.8 and d = 2.8, respectively), and a-tDCS + AE also showed a lower FC compared to the Sham + AE group (d = 1.5). FC remained lower in the a-tDCS + AE group compared to Sham + AE and Control groups at follow-up (d = 1.7 and d = 2.4, respectively). CF was higher in the a-tDCS + AE compared to Sham + AE and Control groups (d = 2.1 and d = 1.4, respectively) and in the sham + AE (d = 1.0) compared to control in Phase 2. At follow-up, CF was higher only in the a-tDCS + AE group compared to the Control (d = 1.2). IMP scores were higher in the a-tDCS + AE group compared to the other groups in Phases 1 (d = 1.0 and d = 1.4) and 2 (d = 5.4 and d = 1.9). RDM was higher in the a-tDCS + AE compared to the Control group in phase 2 (d = 1.3).ConclusionsMultisession a-tDCS combined with four weeks of moderate AE synergistically reduces food cravings and improves related variables to a greater extent than AE alone, with sustained effects, in women with overweight or obesity and symptoms of food craving.Trial registrationThis study was registered in the Iranian Registry of Clinical Trials (IRCT id: IRCT20210617051606N7; Registration date: 04.02.2023).

Effects of Different Intervention Methods on Postural Control in Athletes with Chronic Ankle Instability: A Randomized Controlled Trial.

This study aimed to evaluate the impacts of a 4-week transcranial direct current stimulation (tDCS), balance training (BT), and an integrated program combining tDCS with BT on static and dynamic postural control in athletes suffering from chronic ankle instability (CAI); as well as to explore whether the combined program produces superior effects compared to either single intervention. Forty athletes with CAI were randomized into four groups: tDCS group, sham tDCS (s-tDCS) group, tDCS + BT group, and s-tDCS + BT group. Twenty minutes of 2 mA anodal or sham tDCS was applied either independently or in conjunction with a 20-minute progressive hop-to-stabilization balance (PHSB) training program over 12 supervised sessions spanning 4 weeks. Primary outcomes were the total score of the Balance Error Scoring System (BESS) and the composite reach distance (COMP) in the Y-Balance Test (YBT). Secondary outcome measures included error scores of single-limb and tandem stance on firm and foam surfaces, as well as mean normalized reach distances in the anterior (ANT), posteromedial (PM), and posterolateral (PL) directions. Compared to baseline measures, the tDCS, tDCS + BT, and s-tDCS + BT groups scored fewer errors on posttest measures for single-leg stance on a firm surface (Sfi), single-leg stance on a foam surface (Sfo), tandem stance on a firm surface (Tfi), tandem stance on a foam surface (Tfo), and the total BESS (p < 0.05). Additionally, both the tDCS + BT and the s-tDCS + BT groups showed greater PM, PL, and COMP in posttest measures compared to pretest measures (p < 0.05). However, no significant differences were found among the tDCS group, the tDCS + BT group, and the s-tDCS + BT group in the posttest measures (p > 0.05). tDCS, BT, and the combination of these two interventions can significantly improve static postural stability in athletes with CAI. However, only intervention methods incorporating BT were effective in enhancing dynamic stability. The combined program offered no additional benefits.

Short-term effects of transcranial direct current stimulation on pain sensitivity, emotional and cognitive processes in non-suicidal self-injury: a randomised controlled trial.

Pain sensitivity is critical for preventing non-suicidal self-injury (NSSI) behaviours; however, individuals engaging in such behaviours often exhibit decreased pain sensitivity, which may undermine this natural safeguard. The dorsolateral prefrontal cortex (DLPFC) is a key region involved in pain regulation, and recent approaches using transcranial direct current stimulation (tDCS) to target the DLPFC have shown potential for modulating pain processing and restoring normal pain perception for individuals engaging in NSSI behaviours. This study aimed to explore the immediate and short-term effects of a single session of tDCS on pain sensitivity in individuals with NSSI, as well as its secondary effects on mood and NSSI-related factors. In this randomised, double-blind, parallel, sham-controlled clinical trial, participants with a history of NSSI were randomly assigned to receive either active or sham tDCS. The intervention consisted of a single 20 min tDCS session targeting the left DLPFC. The primary outcome was pain sensitivity, measured by the pressure pain threshold (PPT) and heat pain score (HPS). Secondary and additional outcomes included NSSI urges, NSSI resistance, self-efficacy in resisting NSSI, mood-related variables and exploratory cognitive-affective processes such as rumination, self-criticism and self-perceived pain sensitivity, assessed at baseline, immediately post-intervention, and at 24 hours, 1 week and 2 weeks follow-ups. For the primary outcomes, no significant differences between groups were observed for pain sensitivity (PPT, padj=0.812; HPS, padj=0.608). However, an exploratory sensitivity analysis treating each trial as an individual observation revealed a significant effect on HPS (padj=0.036). For the secondary and additional outcomes, although there were initial improvements in joyful feelings and reductions in negative affect at 2 weeks post-intervention, these effects did not remain significant after multiple comparison corrections. Notably, reductions in rumination were statistically significant at both 1-week and 2-week follow-ups (1 week, padj=0.040; 2 weeks, padj=0.042). There were no significant effects on NSSI urges, NSSI resistance, self-efficacy in resisting NSSI or self-criticism. A single session of tDCS over the left DLPFC did not produce significant changes in pain sensitivity in individuals with NSSI. A sensitivity analysis indicated an effect on heat pain sensitivity, possibly reflecting changes in brain activity, warranting confirmation through neuroimaging. These findings suggest that tDCS warrants further investigation for its potential to influence pain-related cognitive-affective processes in individuals with NSSI.

Multimodal personalization of transcranial direct current stimulation for modulation of sensorimotor integration.

Multimodal personalization of transcranial direct current stimulation for modulation of sensorimotor integration.

Transcranial direct current stimulation combined with an intensive training program for upper limb rehabilitation in children with unilateral cerebral palsy. A randomized controlled pilot study.

Transcranial direct current stimulation combined with an intensive training program for upper limb rehabilitation in children with unilateral cerebral palsy. A randomized controlled pilot study.

Priming the primary motor cortex with transcranial direct current stimulation: Effect on learning the golf putt.

Priming the primary motor cortex (M1) with transcranial direct current stimulation (tDCS) prior to motor practice modulates post-synaptic activity, thereby impacting learning of a motor skill. This effect has been shown for the acquisition of simple motor skills. It is not clear whether priming tDCS can impact the learning/retention of a more naturalistic motor task. We investigated the effects of priming M1 with tDCS on the performance on a golf putting task. We hypothesized that participants who receive tDCS with the cathode over M1 (C-M1) would show better skill acquisition and retention performance, relative to participants who receive tDCS with the anode over M1 (A-M1) or sham tDCS. Thirty-six participants were randomized into three groups: C-M1, A-M1, and sham tDCS. Participants received tDCS (1mA, 20 minutes) prior to practicing golf putting across two days. Performance (error) was measured for each putt. Participants returned on the third day for a retention test. After accounting for baseline performance, the C-M1 group performed significantly better compared to A-M1 [p = 0.02] and sham tDCS [p = 0.01] at the retention test. There was no difference in retention performance between A-M1 and sham tDCS. Our findings partially support the Bienenstock-Cooper-Munro rule of metaplasticity. C-M1 tDCS priming enhanced motor learning, while A-M1 tDCS priming had no effect, relative to sham.

Enhancing Balance and Walking Endurance in Older Adults: The Potential of Transcranial Direct Current Stimulation as an Adjunct to Balance Training, a Randomized, Sham-Controlled, Clinical Trial.

Background: Falls among the elderly present significant physical, psychological, and economic challenges. Fall prevention strategies, such as balance and muscle strengthening exercises, are essential but often require long-term commitment. This study explores the potential of transcranial direct current stimulation (tDCS) as an adjunct to balance training to enhance physical performance in the elderly. Method: A randomized, double-blind, sham-controlled design was employed to compare balance training with active or sham tDCS. Participants underwent baseline assessments, followed by a six-week intervention period. The intervention protocol consisted of 2 mA, 20 min of anodal tDCS over the left primary motor cortex, three times weekly. Post-intervention assessments were conducted a few days after the intervention and follow-up at 4 weeks. Results: Following 18 sessions of anodal tDCS combined with balance exercise training, no significant group differences were observed for the Time Up and Go, One-Leg Standing, lower-limb strength, or the 6 min walk test (6MWT), although both the intervention and control groups demonstrated significant improvements over time. A significant group × time interaction was found only for the 6MWT, with participants in the intervention group exhibiting greater improvements in the 6MWT compared to controls. Conclusions: Anodal tDCS combined with balance exercise training selectively enhanced physical endurance but did not confer additional benefits for balance, gait, or leg strength in healthy older adults. These findings suggest that tDCS may serve as a promising adjunct to exercise for improving endurance-related outcomes in aging populations. Control of various variables for tDCS and exercise is necessary.

Longitudinal Effects of Transcranial Direct Current Stimulation on Daily Rejection-Related Emotions in Borderline Personality Disorder: An Ecological Momentary Assessment Study Protocol.

Borderline Personality Disorder (BPD) is a debilitating mental health condition characterized by emotional dysregulation and interpersonal dysfunction, with perceived social rejection exacerbating these issues. Emerging evidence suggests that a single session of transcranial direct current stimulation (tDCS) over the right ventrolateral prefrontal cortex (rVLPFC) may decrease the unique tendency of BPD patients to feel rejected even when socially included during a laboratory task. This protocol outlines a double-blind, sham-controlled study evaluating the longitudinal effects of repeated anodal tDCS over the right ventrolateral prefrontal cortex (rVLPFC) on rejection-related emotions (RRE) during real-life social interactions in individuals with BPD. Sixty BPD patients will be randomized to receive real or sham tDCS across 10 daily sessions, coupled with an ecological momentary assessment (EMA) protocol capturing emotional and behavioral responses to real-life social interactions over four timepoints: baseline, during treatment, ten days post-treatment, and three months post-treatment. Primary outcomes include changes in RRE, with exploratory analyses examining feelings of social connection, aggressive tendencies, trust toward others, and interpersonal and affective dynamics. Multilevel modeling will assess temporal and group-level effects. Expected Results and Impact: This study aims to establish the efficacy of tDCS in reducing BPD patients' negative emotional response in real-life social situations and to determine whether such effects are maintained in time. The findings could advance the clinical application of tDCS as an adjunctive intervention to alleviate social-emotional impairments in BPD, addressing gaps in current treatment approaches and guiding future research into the neural mechanisms of social emotion regulation.

Investigating the effects of brain stimulation on the neural substrates of inhibition in patients with OCD: A simultaneous tDCS – fMRI study

Inhibition deficits constitute a core characteristic of obsessive-compulsive disorder (OCD). There is evidence in healthy individuals that transcranial direct current stimulation (tDCS) of the pre-supplementary motor area (pre-SMA) leads to a significantly improved inhibition performance. Against this background we investigated the effects of pre-SMA tDCS on inhibition performance and the underlying neural correlates in patients with OCD. Using a double-blind, randomized, sham-controlled, cross-over design (i.e., tDCS sham vs. tDCS stimulation) we investigated the effects of 2 mA anodal tDCS stimulation of the right pre-SMA in a sample of 47 OCD patients. The present study is, to our best knowledge, the first study applying concurrent tDCS-fMRI in patients with OCD. tDCS was applied using the MRI-compatible NeuroConn DC-Stimulator which allowed for a concurrent stimulation, while patients performed an inhibition (i.e., Stroop) task in a 3 T MRI. Imaging data were analysed using a multivariate partial least squares (PLS) approach. tDCS stimulation (vs. sham) was associated with increased activation in a fronto-parieto-cerebellar network comprising, amongst others, the precentral, middle frontal and inferior frontal gyrus, the anterior cingulate and the superior parietal lobe. On the performance level, tDCS stimulation (vs. sham) was linked to an improved inhibition performance in terms of an increased percentage of correct responses in the Stroop task. Present results indicate that tDCS in patients with OCD goes along with an improved inhibition performance as well as activation increases in regions known to be involved in inhibition, motor, and cognitive control. Thus, our findings suggest that tDCS might be a promising method to improve specific impairments in OCD.

Combining transcranial direct current stimulation with music therapy improves cognitive function in schizophrenia: study protocol for a randomized, double-blind, sham-controlled clinical trial.

Despite numerous pharmacological treatments, individuals with schizophrenia continue to exhibit significant residual cognitive impairments, adversely affecting the progression of the illness and their overall quality of life. Preliminary evidence indicates that transcranial direct current stimulation (tDCS) and music therapy (MT) may offer potential benefits for enhancing cognitive function in schizophrenia. This study aims to examine the synergistic efficacy of tDCS and MT on cognitive impairments in individuals with schizophrenia and to elucidate the potential mechanisms involved in this process. The study is designed as a randomized, double-blind, sham-controlled trial. All patients with schizophrenia will be randomly assigned to one of five groups: active tDCS combined with MT group, sham tDCS combined with MT group, active tDCS group, MT group, and a control group. The anodal electrode of tDCS will be positioned over the medial prefrontal cortex (mPFC), while the cathodal electrode will be placed over the visual cortex. MT will incorporate both Western Mozart and traditional Chinese classical music. The protocol involves 30-minute sessions conducted once daily, 5 days per week, for 4 consecutive weeks. The primary outcome measure is change in cognitive function, secondary outcomes include changes in psychotic symptoms, social function, and quality of life. Assessments will be evaluated at baseline (T0), after 2 weeks (T1), and after 4 weeks (T2). Furthermore, we will employ functional near-infrared spectroscopy (fNIRS) to examine hemodynamic changes on the cerebral cortex, and explore the neural effects of this combined treatment approach. This study proposes an innovative non-pharmacological treatment protocol that combines tDCS targeting the mPFC with MT to improve cognitive impairments in schizophrenia. As a proof-of-concept study, it aims to provide empirical evidence for the effectiveness of this combined intervention. Moreover, this study seeks to elucidate the underlying neural mechanisms and offer a rigorous framework for future clinical trials, ultimately providing a novel therapeutic strategy for enhancing cognitive functions in patients with schizophrenia. https://www.chictr.org.cn/, identifier, ChiCTR2400093161. The study is registered with https://www.chictr.org.cn/ under protocol registration number ChiCTR2400093161 (date of registration: 29. November. 2024). It was approved by the Research Ethics Committee of the Second Affiliated Hospital of Xinxiang Medical University (Approval Code: XYEFYLL-2024-82, Approval Date: 6 November 2024). Recruitment began in December 2024.

Neuromodulation through brain stimulation-assisted cognitive training in patients with post-chemotherapy subjective cognitive impairment (Neuromod-PCSCI) after breast cancer: study protocol for a double-blinded randomised controlled trial.

Breast cancer is the most common form of cancer in women. A considerable number of women with breast cancer who have been treated with chemotherapy subsequently develop neurological symptoms such as concentration and memory difficulties (also known as 'chemobrain'). Currently, there are no validated therapeutic approaches available to treat these symptoms. Cognitive training holds the potential to counteract cognitive impairment. Combining cognitive training with concurrent transcranial direct current stimulation (tDCS) could enhance and maintain the effects of this training, potentially providing a new approach to treat post-chemotherapy subjective cognitive impairment (PCSCI). With this study, we aim to investigate the effects of multi-session tDCS over the left dorsolateral prefrontal cortex in combination with cognitive training on cognition and quality of life in women with PCSCI. The Neuromod-PCSCI trial is a monocentric, randomised, double-blind, placebo-controlled study. Fifty-two women with PCSCI after breast cancer therapy will receive a 3-week tDCS-assisted cognitive training with anodal tDCS over the left dorsolateral prefrontal cortex (target intervention), compared with cognitive training plus sham tDCS (control intervention). Cognitive training will consist of a letter updating task. Primary outcome will be the performance in an untrained task (n-back task) after training. In addition, feasibility, safety and tolerability, as well as quality of life and performance in additional untrained tasks will be investigated. A follow-up visit will be performed 1 month after intervention to assess possible long-term effects. In an exploratory approach, structural and functional MRI will be acquired before the intervention and at post-intervention to identify possible neural predictors for successful intervention. Ethical approval was granted by the ethics committee of the University Medicine Greifswald (BB236/20). Results will be available through publications in peer-reviewed journals and presentations at national and international conferences. ClinicalTrials.gov; NCT04817566, registered on 26 March 2021.