Uncorking the limitation—improving dual tasking using transcranial electrical stimulation and task training in the elderly: a systematic review

IntroductionWith aging, dual task (DT) ability declines and is more cognitively demanding than single tasks. Rapidly declining DT performance is regarded as a predictor of neurodegenerative disease. Task training and non-invasive transcranial electrical stimulation (tES) are methods applied to optimize the DT ability of the elderly.MethodsA systematic search was carried out in the PUBMED, TDCS (transcranial direct current stimulation) databases, as well as Web of Science, and a qualitative analysis was conducted in 56 included studies. Aiming to summarize the results of studies that implemented tES, task training, or the combination for improving DT ability and related performance changes in healthy elderly and geriatric patients. For different approaches, the training procedures, parameters, as well as outcomes were discussed.ResultsTask training, particularly cognitive-motor DT training, has more notable effects on improving DT performance in the elderly when compared to the neuromodulation method.DiscussionAnodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (L-DLPFC), or its combination with task training could be promising tools. However, additional evidence is required from aged healthy people and patients, as well as further exploration of electrode montage

Pairing transcranial direct current stimulation and mindfulness meditation in the treatment of fibromyalgia

The lack of effective treatments for managing pain and associated symptoms in fibromyalgia (FM) poses both a clinical challenge and an economic burden on the health sector. Typical FM therapies include an array of pharmacological and non-pharmacological interventions. Commonly used drugs have demonstrated only mild improvements in FM while benefitting only a minority of patients. In this scenario, repeated anodal transcranial direct current stimulation (tDCS) and mindfulness-based interventions have emerged as two promising non-pharmacological treatments for pain relief and improvement of FM-associated symptoms. However, the strength and durability of the therapeutic benefits of these methods vary across studies. The combination of non-pharmacological therapies has been proposed as a way to optimise and bolster the therapeutic effects of monomodal interventions. Although the combination of tDCS and mindfulness meditation (MM) has shown synergistic effects in both healthy individuals and patients with neuropsychiatric disorders and some chronic pain conditions, it has not yet been investigated in patients with FM. The rationale behind exploring this combination was to modulate the brain state via MM, with the goal of boosting the neuroplastic effects of currently recommended conventional tDCS protocols for chronic pain. In this dissertation, the current state of the literature on combining these two methods was reviewed. A sham-controlled randomised pilot clinical study was conducted to test the preliminary therapeutic efficacy and safety of a ten-day intervention concurrently applying anodal tDCS targeting the left primary motor cortex (M1) and MM, administered as a clinicbased treatment, in patients with FM. Prior to the combined therapy, participants received a fiveday training in MM. Patients in the active tDCS group reported a larger clinically meaningful improvement in quality of life following the combined intervention, compared to those receiving sham tDCS paired with MM or treatment-as-usual. No differences in pain reduction and improvements in sleep quality or psychological well-being were observed among the groups. Building on these findings and addressing the limitations of the pilot study, we investigated the therapeutic and mechanistic impact of a ten-day treatment combining anodal tDCS over the left 8 M1 and MM on pain relief, quality of life, and associated symptoms in individuals with FM trained in mindfulness. Participants in this trial completed a four-week brief mindfulness intervention tailored for FM (BMIF) prior to randomisation. The combined treatment was administered as an at-home intervention under remote supervision. To investigate the possible underlying mechanisms, we measured changes in cortical excitability using transcranial magnetic stimulation (TMS) of the left M1. Finally, we implemented a responder analysis approach to decipher the effects of the BMIF and the add-on combination of tDCS and MM with regard to emotion regulation (ER), which is one of the primary targets mediating improvement in symptom burden and management in FM. Although patients showed improvements in clinical symptoms, no superior therapeutic benefits were observed when pairing MM with anodal tDCS, compared to the combination of MM with sham tDCS. Both groups demonstrated substantial and acute pain relief and improvements in quality of life, sleep quality, affect, and psychological well-being following the combined intervention. The lack of group differences in TMS metrics failed to provide meaningful insights into the potential synergistic mechanisms of tDCS and MM. Interestingly, clinical responders to the combined intervention in the active tDCS group exhibited impaired ER compared to the sham group, even suggesting potential antagonistic effects of pairing M1-tDCS with MM for ER. Moreover, the reduction of the cortical excitability of the left M1, likely mediated by daily MM practice, might block the mechanistic consequences of anodal tDCS of the left M1. On the other hand, the nonspecific main effect of time in clinical outcomes, alongside a large significant increase in mindfulness over time, hints at a potential ‘mindfulness effect’, in line with previous studies showing that longer MM practice results in greater therapeutic benefits in FM. The introduction of the Medical Device Regulation in 2021 and the recent reclassification of some of the non-invasive brain stimulation (NIBS) devices (for example, tDCS and TMS) to the same risk level as invasive deep brain stimulation in the European Union have imposed a considerable hindrance to the research and further development of tDCS. A multinational participatory study including different stakeholders involved in the consumption, use, manufacturing, and regulation of NIBS was conducted to address the clinical, academic, legal, ethical, and social concerns surrounding NIBS. The different stakeholders’ perspectives were analysed and compiled to draft a set of recommendations for the use and regulation of NIBS, including tDCS in the European subcontinent. To improve the accessibility of tDCS to patients, 9 the optimisation of currently available NIBS treatments via broader administration and further development of home-based tDCS as well as personalisation of therapy have been suggested by the stakeholders. Stricter regulation of tDCS for non-medical reasons and research focused on higher effectiveness of tDCS, underlying mechanisms, and development of responders were also proposed, among others. Taken together, our work challenges the combination of M1-tDCS and MM as a strategy to optimise tDCS treatment for pain relief and symptom improvement in patients with FM. However, this dissertation highlights the pivotal role of clinical research regarding combined interventions, whereby two therapies beneficial on their own might not necessarily be more effective when combined. Future research should explore the additional effect of combining MM and tDCS compared to tDCS and MM alone and delve deeper into the workings of the combined intervention using more sophisticated neuroimaging tools, with the goal of developing novel and individualised methods to optimise the currently available NIBS technologies for the treatment of FM.2025-08-1

A randomized, double-blinded, sham-controlled pilot clinical trial

Background This double-blinded, randomized and sham-controlled pilot clinical trial aimed to investigate the preliminary clinical efficacy and feasibility of combining mindfulness meditation (MM) and transcranial direct current stimulation (tDCS) for pain and associated symptoms in patients with fibromyalgia syndrome (FMS). Methods Included FMS patients (age: 33 to 70) were randomized to three different groups to receive either ten daily sessions of anodal tDCS over the left primary motor cortex paired with MM for 20 min (active + MM, n = 10), sham tDCS combined with MM (sham + MM, n = 10) or no intervention (NoT, n = 10). Patients in the bimodal therapy groups received a week of training in MM prior to the stimulation. Participants reported pain intensity, the primary outcome, by filling in a pain diary daily throughout the whole study. They were also evaluated for quality of life, pressure pain sensitivity, psychological wellbeing, sleep quality and sleep quantity. Assessments were performed at three time points (baseline, immediately after treatment and one-month follow-up). Results Participants in the active + MM group did not exhibit reduced pain intensity following the bimodal therapy compared to controls. Patients in active group demonstrated clinically meaningful and significantly higher quality of life following the therapeutic intervention than other groups. There was no significant difference among groups regarding pressure pain sensitivity, sleep parameters and psychological scales. The combined treatment was well tolerated among participants, with no serious adverse effects. Conclusion This study was the first to pair these two effective non-pharmacological therapies for pain management in FMS. In the light of an underpowered sample size, repetitive anodal tDCS combined with MM did not improve pain or FMS-associated symptoms. However, patients in the active + MM group reported higher quality of life than the control groups. Studies with more participants and longer follow-ups are required to confirm our findings. Clinical trial registration [ www.drks.de ], identifier [DRKS00023490].Open-Access-Publikationsfonds 202

Stimulated brains and meditative minds: A systematic review on combining low intensity transcranial electrical stimulation and meditation in humans

http://dx.doi.org/10.13039/100018173 International Max Planck Research School for Environmental, Cellular and Molecular Microbiologyhttp://dx.doi.org/10.13039/501100003385 Georg-August-Universität Göttinge

Lower thresholds and stronger adaptation to pain in musicians reflect occupational‐specific adaptations to contact heat stimulation

Abstract Background Extensive audio‐motor training and psychological stress can cause professional musicians acute overstrain‐injury and chronic pain, resulting in damaged careers and diminished quality of life. It has also been previously shown that musicians might perceive pain differently than non‐musicians. Therefore, the aim of our study was to quantify differences between musicians and non‐musicians regarding their subjective responses to painful contact heat stimuli and assess how emotional traits might influence these responses. Methods Upon completing the StateTrait‐Anxiety‐Depression Inventory, 15 healthy musicians and 15 healthy non‐musicians from German universities received 15 noxious contact heat stimuli at the dorsal side of each hand and foot. After each stimulation, participants were asked to provide a pain rating from 0 to 10. Results Musicians not only reported significantly higher pain ratings after the first stimulation but also showed a significantly higher degree of habituation compared to non‐musicians. Additionally, musicians showed a significantly less pronounced difference regarding the pain rating of the hands compared to the feet than non‐musicians. Trait anxiety and trait depression scores had no effect on the pain rating or the habituation. Conclusion The more pronounced habituation of musicians might hint at a neuroplastic nociceptive alteration in musicians. The lack of significance between the psychological traits and their effect on the pain ratings is surprising but could be a result of both participant groups having stressful careers. Significance The findings of this report justify musicians' repetitive sensorimotor training as an important model for plasticity and contribute to a better understanding of pain perception in musicians

Stakeholder perspectives on non-invasive brain stimulation

Abstract Non-invasive brain stimulation (NIBS) techniques such as transcranial direct current stimulation (tDCS) or transcranial magnetic stimulation (TMS) have made great progress in recent years and offer boundless potential for the neuroscientific research and treatment of disorders. However, the possible use of NIBS devices for neuro-doping and neuroenhancement in healthy individuals and the military are poorly regulated. The great potentials and diverse applications can have an impact on the future development of the technology and society. This participatory study therefore aims to summarize the perspectives of different stakeholder groups with the help of qualitative workshops. Nine qualitative on-site and virtual workshops were conducted in the study with 91 individuals from seven stakeholder groups: patients, students, do-it-yourself home users of tDCS, clinical practitioners, industry representatives, philosophers, and policy experts. The co-creative and design-based workshops were tailored to each group to document the wishes, fears, and general comments of the participants. The outlooks from each group were collected in written form and summarized into different categories. The result is a comprehensive overview of the different aspects that need to be considered in the field of NIBS. For example, several groups expressed the wish for home-based tDCS under medical supervision as a potential therapeutic intervention and discussed the associated technical specifications. Other topics that were addressed were performance enhancement for certain professional groups, training requirements for practitioners, and questions of agency, among others. This qualitative participatory research highlights the potential of tDCS and repetitive TMS as alternative therapies to medication, with fewer adverse effects and home-based use for tDCS. The ethical and societal impact of the abuse of NIBS for non-clinical use must be considered for policy-making and regulation implementations. This study adds to the neuroethical debate on the responsible use and application of NIBS technologies, taking into consideration the different perspectives of important stakeholders in the field

The evolving landscape of neuromodulation for pain care

Here, we present five different insights on the use of neuromodulation strategies for effective pain management in clinical practice. Experts briefly illustrate the various techniques available and the complexities involved in evaluating their effectiveness. Additionally, they highlight the challenges for widespread adoption in clinical practice and explore some future directions. These viewpoints underscore the evolving landscape of neuromodulation in pain management and the ongoing efforts to optimize these treatments for diverse patient needs.</p

Design-based methods for exploring ethical questions in the field of neurotechnologies

Numerous complex and multi-faceted ethical questions arise from the innovation of neurotechnologies. Addressing these issues effectively requires the involvement of a diverse range of stakeholders, including patients, treatment providers, home users, scientists and engineers from different disciplines, and industry representatives. Different groups, however, possess varying levels of knowledge and experience regarding the ethical use and innovation of neurotechnologies. Therefore, customized methods are needed to identify their perspectives and ethical concerns. This article aims to introduce practical methods for eliciting ethical questions in the field of neurotechnology, including user journeys, persona approaches, material thinking, scenario building, fictional media contributions, and categorization