Integrating home monitoring for transcranial direct current stimulation (tDCS) therapy to professional care environment

Daily management of neurodegenerative diseases is one of the most striking scenarios where an integrated health care system is essential for the continuous assistance to the patient and requires qualification of the caregivers and their training. In particular, patients affected by depression or chronic pain, as well as rehabilitating after stroke, can be treated at home with non-invasive electrical neuromodulation (transcranial Direct Current Stimulation, tDCS) in order to reduce daily travel expenses between home and hospital. Home monitoring of patient undergoing tDCS is essential to (1) optimize the stimulation parameters according to the current health status and to the stimulation outcomes, and (2) assess disease progression. However, monitoring effectiveness depends on the exchange of this information between the patient at home and his/her reference neurologist. Currently, the health IT scenario is composed by two independent environments, one dedicated to healthcare professionals (e.g., Electronic Health Records, EHRs), and one including mobile devices applications dedicated to citizens, caregivers and patients. Safety, communication and interoperability gaps prevented from an effective data exchange between these two environments. The aim of our work is to implement an integrated home monitoring system for tDCS patients, in which a web-based platform for EHR management exchanges data with a patient\u2019s mobile app

Guidelines for TMS/tES Clinical Services and Research through the COVID-19 Pandemic

BACKGROUND: The COVID-19 pandemic has broadly disrupted biomedical treatment and research including non-invasive brain stimulation (NIBS). Moreover, the rapid onset of societal disruption and evolving regulatory restrictions may not have allowed for systematic planning of how clinical and research work may continue throughout the pandemic or be restarted as restrictions are abated. The urgency to provide and develop NIBS as an intervention for diverse neurological and mental health indications, and as a catalyst of fundamental brain research, is not dampened by the parallel efforts to address the most life-threatening aspects of COVID-19; rather in many cases the need for NIBS is heightened including the potential to mitigate mental health consequences related to COVID-19. OBJECTIVE: To facilitate the re-establishment of access to NIBS clinical services and research operations during the current COVID-19 pandemic and possible future outbreaks, we develop and discuss a framework for balancing the importance of NIBS operations with safety considerations, while addressing the needs of all stakeholders. We focus on Transcranial Magnetic Stimulation (TMS) and low intensity transcranial Electrical Stimulation (tES) - including transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS). METHODS: The present consensus paper provides guidelines and good practices for managing and reopening NIBS clinics and laboratories through the immediate and ongoing stages of COVID-19. The document reflects the analysis of experts with domain relevant expertise spanning NIBS technology, clinical services, and basic and clinical research - with an international perspective. We outline regulatory aspects, human resources, NIBS optimization, as well as accommodations for specific demographics. RESULTS: A model based on three phases (early COVID-19 impact, current practices, and future preparation) with an 11-step checklist (spanning removing or streamlining in-person protocols, incorporating telemedicine, and addressing COVID-19-associated adverse events) is proposed. Recommendations on implementing social distancing and sterilization of NIBS related equipment, specific considerations of COVID-19 positive populations including mental health comorbidities, as well as considerations regarding regulatory and human resource in the era of COVID-19 are outlined. We discuss COVID-19 considerations specifically for clinical (sub-)populations including pediatric, stroke, addiction, and the elderly. Numerous case-examples across the world are described. CONCLUSION: There is an evident, and in cases urgent, need to maintain NIBS operations through the COVID-19 pandemic, including anticipating future pandemic waves and addressing effects of COVID-19 on brain and mind. The proposed robust and structured strategy aims to address the current and anticipated future challenges while maintaining scientific rigor and managing risk

About psychotic-like experiences and auditory verbal hallucinations : Transdiagnostic investigations of neurobiological, cognitive, and emotional aspects of a continuous phenomenon

Hallucinations and delusions are known to be key symptoms of psychotic disorders, such as schizophrenia, and have been studied extensively. However, these experiences also occur in other mental disorders, which suggests a transdiagnostic perspective with shared underlying cognitive mechanisms across various psychological illnesses. In addition, hallucinations and delusions are continuous phenomena that occur not only in patients with mental disorders, but also in healthy individuals in the general population, spanning from childhood to adulthood. To understand the development and maintenance of such psychotic-like experiences (PLEs) in general, and auditory verbal hallucinations (AVHs) specifically, neurobiological, cognitive, and emotional factors need to be taken into consideration. The aim of this thesis is to examine these factors by investigating underlying brain mechanisms of inner speech processes, the impact of emotions, and core schemas about the self and others in different groups of individuals along the continuum from healthy individuals to voice hearers with different underlying disorders. In paper 1, we investigated PLEs in Norway in a sample from the general population, using the screening questions of the Questionnaire for Psychotic Experiences (QPE), an interview that captures the presence and phenomenology of various psychotic experiences separately. Participants with mental disorders reported more frequent lifetime and current hallucinatory experiences than participants without mental disorders, with childhood experiences being rather low. We further replicated findings that young age, illegal drug use, lower level of education, and having parents with a mental disorder are associated with higher endorsement rates of PLEs. Finally, we revealed that the mere presence of PLEs does not discriminate between individuals with and without a mental disorder. Taken together, the findings of paper 1 support existing models that both hallucinations and delusions exist on a structural and phenomenological continuum. In paper 2, we investigated neurobiological factors of cognitive inner speech processes by using a neurostimulation method called transcranial direct current stimulation (tDCS) to modulate source monitoring abilities in healthy individuals. We modulated reality monitoring (distinguishing between external and internal sources) and internal source monitoring abilities (distinguishing between two or more internal sources). We found that internal source monitoring abilities were significantly enhanced during active online tDCS, while reality monitoring abilities were unaffected by stimulation. Our findings suggest that there are different brain areas involved in reality and internal source monitoring: Internal source monitoring seems to involve Broca’s area. Reality monitoring, however, seems to rely more on the superior temporal gyrus (STG) and the dorsolateral prefrontal cortex (DLPFC) as shown in other studies. In paper 3, we focused on cognitive and emotional aspects of AVHs, namely the impact of emotions and affect on AVH phenomenology in non-clinical and different clinical populations. Depending on the underlying psychopathology, these phenomena show different phenomenological aspects. Our aim was to determine the mediating roles of anxiety and depression in the relationship between positive and negative core schemas about the self and others, and emotional aspects of AVHs for three groups: non clinical voice hearers, affective voice hearers, and non-affective voice hearers. Results showed full mediating effects of anxiety in affective voice hearers in the relationship between negative core schemas and all phenomenological aspects, but not in non-affective voice hearers. Depression was not a mediator in any of the groups. These findings suggest different emotional mechanisms for different groups of voice hearers, depending on the underlying psychopathology of individuals with AVHs. Overall, we conclude that the findings support a continuous and transdiagnostic perspective of PLEs in general, and AVHs specifically. However, more integrative transdiagnostic investigations in different groups of individuals along the continuum are needed as studying AVHs in only one modality or one clinical population is unlikely to bring us closer to understanding how these phenomena develop in the first place.Doktorgradsavhandlin

Augmentation of Brain Function: Facts, Fiction and Controversy. Volume III: From Clinical Applications to Ethical Issues and Futuristic Ideas

The final volume in this tripartite series on Brain Augmentation is entitled “From Clinical Applications to Ethical Issues and Futuristic Ideas”. Many of the articles within this volume deal with translational efforts taking the results of experiments on laboratory animals and applying them to humans. In many cases, these interventions are intended to help people with disabilities in such a way so as to either restore or extend brain function. Traditionally, therapies in brain augmentation have included electrical and pharmacological techniques. In contrast, some of the techniques discussed in this volume add specificity by targeting select neural populations. This approach opens the door to where and how to promote the best interventions. Along the way, results have empowered the medical profession by expanding their understanding of brain function. Articles in this volume relate novel clinical solutions for a host of neurological and psychiatric conditions such as stroke, Parkinson’s disease, Huntington’s disease, epilepsy, dementia, Alzheimer’s disease, autism spectrum disorders (ASD), traumatic brain injury, and disorders of consciousness. In disease, symptoms and signs denote a departure from normal function. Brain augmentation has now been used to target both the core symptoms that provide specificity in the diagnosis of a disease, as well as other constitutional symptoms that may greatly handicap the individual. The volume provides a report on the use of repetitive transcranial magnetic stimulation (rTMS) in ASD with reported improvements of core deficits (i.e., executive functions). TMS in this regard departs from the present-day trend towards symptomatic treatment that leaves unaltered the root cause of the condition. In diseases, such as schizophrenia, brain augmentation approaches hold promise to avoid lengthy pharmacological interventions that are usually riddled with side effects or those with limiting returns as in the case of Parkinson’s disease. Brain stimulation can also be used to treat auditory verbal hallucination, visuospatial (hemispatial) neglect, and pain in patients suffering from multiple sclerosis. The brain acts as a telecommunication transceiver wherein different bandwidth of frequencies (brainwave oscillations) transmit information. Their baseline levels correlate with certain behavioral states. The proper integration of brain oscillations provides for the phenomenon of binding and central coherence. Brain augmentation may foster the normalization of brain oscillations in nervous system disorders. These techniques hold the promise of being applied remotely (under the supervision of medical personnel), thus overcoming the obstacle of travel in order to obtain healthcare. At present, traditional thinking would argue the possibility of synergism among different modalities of brain augmentation as a way of increasing their overall effectiveness and improving therapeutic selectivity. Thinking outside of the box would also provide for the implementation of brain-to-brain interfaces where techniques, proper to artificial intelligence, could allow us to surpass the limits of natural selection or enable communications between several individual brains sharing memories, or even a global brain capable of self-organization. Not all brains are created equal. Brain stimulation studies suggest large individual variability in response that may affect overall recovery/treatment, or modify desired effects of a given intervention. The subject’s age, gender, hormonal levels may affect an individual’s cortical excitability. In addition, this volume discusses the role of social interactions in the operations of augmenting technologies. Finally, augmenting methods could be applied to modulate consciousness, even though its neural mechanisms are poorly understood. Finally, this volume should be taken as a debate on social, moral and ethical issues on neurotechnologies. Brain enhancement may transform the individual into someone or something else. These techniques bypass the usual routes of accommodation to environmental exigencies that exalted our personal fortitude: learning, exercising, and diet. This will allow humans to preselect desired characteristics and realize consequent rewards without having to overcome adversity through more laborious means. The concern is that humans may be playing God, and the possibility of an expanding gap in social equity where brain enhancements may be selectively available to the wealthier individuals. These issues are discussed by a number of articles in this volume. Also discussed are the relationship between the diminishment and enhancement following the application of brain-augmenting technologies, the problem of “mind control” with BMI technologies, free will the duty to use cognitive enhancers in high-responsibility professions, determining the population of people in need of brain enhancement, informed public policy, cognitive biases, and the hype caused by the development of brain- augmenting approaches

Drugs, games, and devices for enhancing cognition: implications for work and society.

As work environments change, the demands on working people change. Cognitive abilities in particular are becoming progressively more important for work performance and successful competition in a global environment. However, work-related stress, performance over long hours, lack of sleep, shift work, and jet lag affect cognitive functions. Therefore, an increasing number of healthy people are reported to use cognitive-enhancing drugs, as well as other interventions, such as noninvasive brain stimulation, to maintain or improve work performance. This review summarizes research on pharmacological and technical methods as well as cognitive training, including game apps for the brain, in healthy people. In neuropsychiatric disorders, impairments in cognitive functions can drastically reduce the chances of returning to work; therefore, this review also summarizes findings from pharmacological and cognitive-training studies in neuropsychiatric disorders.All cited psychopharmacological work from Professor Sahakian laboratory was funded by a Wellcome Trust Grant (089589/Z/09/Z) awarded to T.W. Robbins, B.J. Everitt, A.C. Roberts, J.W. Dalley, and B.J. Sahakian, and it was conducted at the Behavioural and Clinical Neuroscience Institute, which is supported by a joint award from the Medical Research Council and Wellcome Trust (G00001354). ABB was supported by a grant from the The Wallitt Foundation.This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1111/nyas.1304

Drugs, games, and devices for enhancing cognition: implications for work and society

As work environments change, the demands on working people change. Cognitive abilities in particular are becoming progressively more important for work performance and successful competition in a global environment. However, work-related stress, performance over long hours, lack of sleep, shift work, and jet lag affect cognitive functions. Therefore, an increasing number of healthy people are reported to use cognitive-enhancing drugs, as well as other interventions, such as noninvasive brain stimulation, to maintain or improve work performance. This review summarizes research on pharmacological and technical methods as well as cognitive training, including game apps for the brain, in healthy people. In neuropsychiatric disorders, impairments in cognitive functions can drastically reduce the chances of returning to work; therefore, this review also summarizes findings from pharmacological and cognitive-training studies in neuropsychiatric disorders.All cited psychopharmacological work from Professor Sahakian laboratory was funded by a Wellcome Trust Grant (089589/Z/09/Z) awarded to T.W. Robbins, B.J. Everitt, A.C. Roberts, J.W. Dalley, and B.J. Sahakian, and it was conducted at the Behavioural and Clinical Neuroscience Institute, which is supported by a joint award from the Medical Research Council and Wellcome Trust (G00001354). ABB was supported by a grant from the The Wallitt Foundation.This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1111/nyas.1304

Training in the practice of noninvasive brain stimulation: Recommendations from an IFCN committee

As the field of noninvasive brain stimulation (NIBS) expands, there is a growing need for comprehensive guidelines on training practitioners in the safe and effective administration of NIBS techniques in their various research and clinical applications. This article provides recommendations on the structure and content of this training. Three different types of practitioners are considered (Technicians, Clinicians, and Scientists), to attempt to cover the range of education and responsibilities of practitioners in NIBS from the laboratory to the clinic. Basic or core competencies and more advanced knowledge and skills are discussed, and recommendations offered regarding didactic and practical curricular components. We encourage individual licensing and governing bodies to implement these guidelines

Inhibitory Control Training

Inhibitory control is a critical neurocognitive skill for navigating cognitive, social, and emotional challenges. It rapidly increases during the preschool period and is important for early cognitive development, as it is a crucial component of executive functioning, self-regulation, and impulsivity. Inhibitory control training (ICT) is a novel intervention in which participants learn to associate appetitive cues with inhibition of behavior. It is being considered a promising approach in the treatment of psychopathology and appetitive behaviors. This book aims to bring together knowledge on the topic, considering research, clinic, and forensic field of intervention. Indeed, this book can be considered an excellent synopsis of perspectives, methods, empirical evidence, and international references

The Effects of Transcranial Direct Current Stimulation (tDCS) on Facial Expression Approach/Avoidance in College Students and Faculty with Broad Autism Phenotype

Transcranial Direct Current Stimulation (tDCS) has been proposed as an alternative noninvasive therapy for individuals with autism. This study trained brain activity in college students and / or faculty with Broad Autism Phenotype (BAP) while eye tracking data was collected. The purpose of this study was to determine if tDCS training to the frontal lobes could increase approach toward social interactions in adults classified as BAP as demonstrated by eye-tracking measures in response to faces and gaze fixation. The study included 21 total participants recruited from the Science, Technology, Engineering, and Math (STEM) courses / professions at a Regional East Texas University. Participants were classified as BAP+ based on their scores on the Broad Autism Phenotype Questionnaire (BAPQ). Findings revealed statistically significant differences in the participant revisit gaze and a trend in reduction of fixations and in fixation duration increase after tDCS stimulation. Additionally, this study found a moderate correlation between BAPQ scores and revisit revistors and suggested the closer the family member of the BAP+ participant, the higher the BAP score. The results of the current study support the integration of eye tracking to provide early identification and intervention and propagate the importance of clinicians’ and researchers’ focus on the factors that modulate eye tracking measures to reduce symptomology of ASD and BAP as well as other conditions with overlapping brain regions

Training in the practice of noninvasive brain stimulation: Recommendations from an IFCN committee

© 2020 As the field of noninvasive brain stimulation (NIBS) expands, there is a growing need for comprehensive guidelines on training practitioners in the safe and effective administration of NIBS techniques in their various research and clinical applications. This article provides recommendations on the structure and content of this training. Three different types of practitioners are considered (Technicians, Clinicians, and Scientists), to attempt to cover the range of education and responsibilities of practitioners in NIBS from the laboratory to the clinic. Basic or core competencies and more advanced knowledge and skills are discussed, and recommendations offered regarding didactic and practical curricular components. We encourage individual licensing and governing bodies to implement these guidelines