Combining physical training with transcranial direct current stimulation to improve gait in Parkinson's disease: a pilot randomized controlled study

OBJECTIVE: To improve gait and balance in patients with Parkinson's disease by combining anodal transcranial direct current stimulation with physical training. DESIGN: In a double-blind design, one group (physical training; n = 8) underwent gait and balance training during transcranial direct current stimulation (tDCS; real/sham). Real stimulation consisted of 15 minutes of 2 mA transcranial direct current stimulation over primary motor and premotor cortex. For sham, the current was switched off after 30 seconds. Patients received the opposite stimulation (sham/real) with physical training one week later; the second group (No physical training; n = 8) received stimulation (real/sham) but no training, and also repeated a sequential transcranial direct current stimulation session one week later (sham/real). SETTING: Hospital Srio Libanes, Buenos Aires, Argentina. SUBJECTS: Sixteen community-dwelling patients with Parkinson's disease. INTERVENTIONS: Transcranial direct current stimulation with and without concomitant physical training. MAIN MEASURES: Gait velocity (primary gait outcome), stride length, timed 6-minute walk test, Timed Up and Go Test (secondary outcomes), and performance on the pull test (primary balance outcome). RESULTS: Transcranial direct current stimulation with physical training increased gait velocity (mean = 29.5%, SD = 13; p < 0.01) and improved balance (pull test: mean = 50.9%, SD = 37; p = 0.01) compared with transcranial direct current stimulation alone. There was no isolated benefit of transcranial direct current stimulation alone. Although physical training improved gait velocity (mean = 15.5%, SD = 12.3; p = 0.03), these effects were comparatively less than with combined tDCS + physical therapy (p < 0.025). Greater stimulation-related improvements were seen in patients with more advanced disease. CONCLUSIONS: Anodal transcranial direct current stimulation during physical training improves gait and balance in patients with Parkinson's disease. Power calculations revealed that 14 patients per treatment arm (α = 0.05; power = 0.8) are required for a definitive trial

Effects of single session cathodal transcranial direct current stimulation on tic symptoms in Tourette's syndrome

Tourette syndrome is a neurodevelopmental disorder characterised by motor and phonic tics. For some, tics can be managed using medication and/or forms of behavioural therapy, however, adverse side effects and access to specialist resources can be barriers to treatment.In this sham-controlled brain stimulation study, we investigated the effects of transcranial direct current stimulation (tDCS) on the occurrence of tics and motor cortical excitability in individuals aged 16-33 years with Tourette syndrome. Changes in tics were measured using video recordings scored using the RUSH method (Goetz et al., 1999) and changes in cortical excitability were measured using single pulse transcranial magnetic stimulation (spTMS) over the primary motor cortex (M1). Video recordings and spTMS measures were taken before and after twenty minutes of sham or active tDCS: during which cathodal current was delivered to an electrode placed above the supplementary motor area (SMA).Tic impairment scores, calculated from the video data, were significantly lower post cathodal stimulation in comparison to post sham stimulation, however the interaction between time (pre/post) and stimulation (cathodal/sham) was not significant There was no indication of a statistically significant change in M1 cortical excitability following SMA stimulation. This study presents tentative evidence that tDCS may be helpful in reducing tics for some individuals, and provides a foundation for larger scale explorations of the use of tDCS as a treatment for reducing tics

Modulation of the Sodium/Potassium ATPase Function and Expression by Transcranial Direct Current Stimulation of the Right Sensorimotor Cortex in Mice

Direct current stimulation is used as a noninvasive therapeutic technique to enhance motor recovery following stroke, and to improve cognitive functions. This technique also showed promising results in the treatment of depression, schizophrenia, and multiple sclerosis. Transcranial direct current stimulation has been proven to cause a polarization (depolarization or hyperpolarization) of the target tissues depending on the polarity of the current and cell orientation. Because of the induced polarization, the spontaneous activity of the neurons is further affected. With exception to this electrophysiological effect, the overall biological mechanisms of transcranial direct current stimulation on the underlying tissues remain largely unknown. The present study aimed to reveal the effects of this technique on molecular targets that play a role in the generation and maintenance of cells’ membrane potentials. More specifically, this study focused on the sodium/potassium ATPase whose role in the generation of the membrane potential is essential. It also focused on other molecules that control the activity of the pump. Findings of this study revealed that cathode transcranial direct current stimulation increases the expression of alpha1 sodium/potassium ATPase protein and gene. The expression of beta 2 sodium/potassium ATPase was also increased following anode direct current stimulation. Similarly, the expression of alpha 1 sodium/potassium ATPase phospho-serine 943 and alpha 1 sodium/potassium ATPase phospho-serine 23 increased after anode transcranial direct stimulation. Taken together, these results showed that transcranial direct current stimulation influences the expression and regulation of the sodium/potassium ATPase

The Effectiveness of Cognitive Training Method and Transcranial Direct Current Stimulation (tDCS) on the Metamemory in the Students with Special Learning Disorders

Background: The present study was aimed to determine the effectiveness of cognitive training method and transcranial direct current stimulation (tDCS) on the metamemory in the students with special learning disorders. Methods: The study has been conducted based on a semi-experimental design of pretest-posttest type with control group. Forty-five students were selected based on a purposive sampling method and assigned to two groups, a control group and an experimental group (each containing 15 individuals) based on a simple randomized method. One of the experimental groups received cognitive training for a period of 20 to 30 sessions, each 45 minutes (twice a week) and the other group was subjected to transcranial direct current stimulation for 20 minutes during ten consecutive days. The statistical method of choice was multivariate covariance analysis (ANCOVA). Significant level was set at 0.05. Results: The results of data analysis using covariance analysis indicated that both of the cognitive training method and the transcranial direct current stimulation (tDCS) were effective in the metamemory (Pvalue&lt;0.01). Conclusions: Cognitive training and the transcranial direct current stimulation (tDCS) methods can be applied for improving the metamemory in students with special learning disabilities. &nbsp;Keywords: Metamemory, Cognitive training, Learning disabilities, Transcranial direct current stimulation (tDCS)

The Effectiveness of Cognitive Training Method and Transcranial Direct Current Stimulation (tDCS) on the Metamemory in the Students with Special Learning Disorders

Background: The present study was aimed to determine the effectiveness of cognitive training method and transcranial direct current stimulation (tDCS) on the metamemory in the students with special learning disorders. Methods: The study has been conducted based on a semi-experimental design of pretest-posttest type with control group. Forty-five students were selected based on a purposive sampling method and assigned to two groups, a control group and an experimental group (each containing 15 individuals) based on a simple randomized method. One of the experimental groups received cognitive training for a period of 20 to 30 sessions, each 45 minutes (twice a week) and the other group was subjected to transcranial direct current stimulation for 20 minutes during ten consecutive days. The statistical method of choice was multivariate covariance analysis (ANCOVA). Significant level was set at 0.05. Results: The results of data analysis using covariance analysis indicated that both of the cognitive training method and the transcranial direct current stimulation (tDCS) were effective in the metamemory (Pvalue&lt;0.01). Conclusions: Cognitive training and the transcranial direct current stimulation (tDCS) methods can be applied for improving the metamemory in students with special learning disabilities. &nbsp;Keywords: Metamemory, Cognitive training, Learning disabilities, Transcranial direct current stimulation (tDCS)

Brain complexity in stroke recovery after bihemispheric transcranial direct current stimulation in mice

Stroke is one of the leading causes of disability worldwide. There are many different rehabilitation approaches aimed at improving clinical outcomes for stroke survivors. One of the latest therapeutic techniques is the non-invasive brain stimulation. Among non-invasive brain stimulation, transcranial direct current stimulation has shown promising results in enhancing motor and cognitive recovery both in animal models of stroke and stroke survivors. In this framework, one of the most innovative methods is the bihemispheric transcranial direct current stimulation that simultaneously increases excitability in one hemisphere and decreases excitability in the contralateral one. As bihemispheric transcranial direct current stimulation can create a more balanced modulation of brain activity, this approach may be particularly useful in counteracting imbalanced brain activity, such as in stroke. Given these premises, the aim of the current study has been to explore the recovery after stroke in mice that underwent a bihemispheric transcranial direct current stimulation treatment, by recording their electric brain activity with local field potential and by measuring behavioural outcomes of Grip Strength test. An innovative parameter that explores the complexity of signals, namely the Entropy, recently adopted to describe brain activity in physiopathological states, was evaluated to analyse local field potential data. Results showed that stroke mice had higher values of Entropy compared to healthy mice, indicating an increase in brain complexity and signal disorder due to the stroke. Additionally, the bihemispheric transcranial direct current stimulation reduced Entropy in both healthy and stroke mice compared to sham stimulated mice, with a greater effect in stroke mice. Moreover, correlation analysis showed a negative correlation between Entropy and Grip Strength values, indicating that higher Entropy values resulted in lower Grip Strength engagement. Concluding, the current evidence suggests that the Entropy index of brain complexity characterizes stroke pathology and recovery. Together with this, bihemispheric transcranial direct current stimulation can modulate brain rhythms in animal models of stroke, providing potentially new avenues for rehabilitation in humans.Miraglia et al. demonstrated-in a stroke mouse model-that brain activity changes, measured by Entropy index, correlate with stroke. They also demonstrated that transcranial direct current stimulation ameliorates post-stroke deficits and Entropy correlates with functional recovery. The authors concluded that Entropy could characterize stroke pathology and predict stroke outcomes.Graphical Abstrac

Efficacy of transcranial direct-current stimulation (tDCS) in women with provoked vestibulodynia: study protocol for a randomized controlled trial

Abstract: Background: Provoked vestibulodynia is the most common form of vulvodynia. Despite its high prevalence and deleterious sexual, conjugal, and psychological repercussions, effective evidence-based interventions for provoked vestibulodynia remain limited. For a high proportion of women, significant pain persists despite the currently available treatments. Growing evidence suggests that the central nervous system (CNS) could play a key role in provoked vestibulodynia; thus, treatment targeting the CNS, rather than localized dysfunctions, may be beneficial for women suffering from provoked vestibulodynia. In this study, we aim to build on the promising results of a previous case report and evaluate whether transcranial direct-current stimulation, a non-invasive brain stimulation technique targeting the CNS, could be an effective treatment option for women with provoked vestibulodynia. Methods/design: This single-center, triple-blind, parallel group, randomized, controlled trial aims to compare the efficacy of transcranial direct-current stimulation with sham transcranial direct-current stimulation in women with provoked vestibulodynia. Forty women diagnosed with provoked vestibulodynia by a gynecologist, following a standardized treatment protocol, are randomized to either active transcranial direct-current stimulation treatment for ten sessions of 20 minutes at an intensity of 2 mA or sham transcranial direct-current stimulation over a 2-week period. Outcome measures are collected at baseline, 2 weeks after treatment and at 3-month follow-up. The primary outcome is pain during intercourse, assessed with a numerical rating scale. Secondary measurements focus on the sexual function, vestibular pain sensitivity, psychological distress, treatment satisfaction, and the patient’s global impression of change. Discussion: To our knowledge, this study is the first randomized controlled trial to examine the efficacy of transcranial direct-current stimulation in women with provoked vestibulodynia. Findings from this trial are expected to provide significant information about a promising intervention targeting the centralization of pain in women with provoked vestibulodynia

No efficacy of transcranial direct current stimulation on chronic migraine with medication overuse : a double blind, randomised clinical trial

Background: Transcranial direct current stimulation was suggested to provide beneficial effects in chronic migraine, a condition often associated with medication overuse for which no long-term therapy is available. Methods: We conducted a randomised controlled trial to assess long-term efficacy of transcranial direct current stimulation. Adults diagnosed with chronic migraine and medication overuse were assigned to receive in a 1:1:1 ratio anodal, cathodal, or sham transcranial direct current stimulation daily for five consecutive days, along with standardised drug withdrawal protocol. Primary outcome was 50% reduction of days of headache per month at 12 months. Co-secondary outcomes were 50% reduction of days of headache per month at 6 months, reduction of analgesic intake per month, and change in disability and quality of life, catastrophising, depression, state and trait anxiety, dependence attitude and allodynia intensity. Patients were not allowed to take any migraine prophylaxis drug for the entire study period. Results: We randomly allocated 135 patients to anodal (44), cathodal (45), and sham (46) transcranial direct current stimulation. At 6 and 12 months, the percentage of reduction of days of headache and number of analgesics per month ranged between 48.5% and 64.7%, without differences between transcranial direct current stimulation (cathodal, anodal, or the results obtained from the two arms of treatment, anodal plus cathodal) and sham. Catastrophising attitude significantly reduced at 12 months in all groups. There was no difference for the other secondary outcomes. Conclusions: Transcranial direct current stimulation did not influence the short and long-term course of chronic migraine with medication overuse after acute drug withdrawal. Behavioral and educational measures and support for patients' pain management could provide long-term improvement and low relapse rate. Trial registration number NCT04228809