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Challenges and Opportunities in Application of Transcranial Direct Current Stimulation (tDCS)

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Brain Injury".

Deadline for manuscript submissions: closed (1 March 2023) | Viewed by 12281

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Special Issue Editors

Prof. Dr. Hyochol Ahn

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Guest Editor

College of Nursing, Florida State University, Tallahassee, FL, USA
Interests: clinical trial; brain stimulation; brain imaging; pain; dementia; neurocognitive and psychosocial symptoms

Prof. Dr. Antonio L. Teixeira

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Guest Editor

McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
Interests: Alzheimer’s disease; Huntington’s diseases; neuropsychiatric disorders; brain stimulation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In recent years, we have experienced epochal changes in the transcranial direct current stimulation (tDCS) field, especially regarding its therapeutic applications. A growing body of evidence has suggested that tDCS has a significant impact on symptom management in various conditions, including pain and neurocognitive and behavioral disorders. Moreover, advances such as home-based tDCS intervention with real-time monitoring have expanded its potential use in real-world scenarios, but several challenges remain.

We believe that your collaboration in this Special Issue of the Journal of Clinical Medicine entitled “Challenges and Opportunities in Application of Transcranial Direct Current Stimulation (tDCS)” will contribute to the dissemination of current knowledge regarding tDCS, from its neurobiological bases to practical or clinical applications.

Prof. Dr. Hyochol Ahn
Prof. Dr. Antonio L. Teixeira
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

transcranial direct current stimulation (tDCS)
neuroimaging
neuromodulation
brain imaging
symptom management

Published Papers (5 papers)

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Research

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16 pages, 765 KiB

Open AccessArticle

Safety and Tolerability of tDCS across Different Ages, Sexes, Diagnoses, and Amperages: A Randomized Double-Blind Controlled Study

by Derrick M. Buchanan, Sarah Amare, Genevieve Gaumond, Amedeo D’Angiulli and Philippe Robaey

J. Clin. Med. 2023, 12(13), 4346; https://doi.org/10.3390/jcm12134346 - 28 Jun 2023

Cited by 1 | Viewed by 1762

Abstract

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique with substantial evidence for its safety and tolerability in adults. However, less than 5% of published tDCS research is in pediatrics. Our primary objective was to investigate tDCS safety, tolerability, and acceptability in a sample of children and adults. We hypothesized that children and adults would be equal with regard to tDCS safety, tolerability, and acceptability. We tested this hypothesis using a Bayesian approach. Sixty participants aged 6–45 (balanced for sex) participated in a randomized double-blind controlled trial. They were randomly assigned to two ten-minute tDCS sessions with varying amperages and electrode locations. The primary outcome measure of this study was the intensity of 13 potential side effects evaluated at six different time points spanning two weeks. Independent sample Bayes factor tests were conducted between children/adults, males/females, clinical/healthy, and low/high amperage groups. As predicted, there was moderate support for the null hypothesis in all between-group analyses. There were no serious adverse events or dropouts, and the number needed to treat for an additional harmful outcome was 23. This study provided evidence supporting the overall short-term safety, tolerability, and acceptability of tDCS including amperages up to 2 mA and different electrode placements. Full article

(This article belongs to the Special Issue Challenges and Opportunities in Application of Transcranial Direct Current Stimulation (tDCS))

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9 pages, 491 KiB

Open AccessArticle

Efficacy of Home-Based Transcranial Direct Current Stimulation on Experimental Pain Sensitivity in Older Adults with Knee Osteoarthritis: A Randomized, Sham-Controlled Clinical Trial

by Geraldine Martorella, Kenneth Mathis, Hongyu Miao, Duo Wang, Lindsey Park and Hyochol Ahn

J. Clin. Med. 2022, 11(17), 5209; https://doi.org/10.3390/jcm11175209 - 02 Sep 2022

Cited by 5 | Viewed by 1676

Abstract

Although transcranial direct current stimulation (tDCS) is encouraging regarding clinical pain intensity for individuals with knee osteoarthritis, very few studies have explored its impact on experimental pain sensitivity, which may hinder our understanding of underlying therapeutic mechanisms. The purpose of this study was to assess the efficacy of 15 home-based tDCS sessions on experimental pain sensitivity and explore its relationships with clinical pain intensity. We randomly assigned 120 participants to active tDCS (n = 60) and sham tDCS (n = 60). Quantitative sensory testing (QST) was used, including heat pain threshold and tolerance, pressure pain threshold, and conditioned pain modulation. Patients in the active tDCS group exhibited reduced experimental pain sensitivity as reflected by all QST measures at the end of treatment. Furthermore, correlations were observed between changes in clinical pain intensity and experimental pain sensitivity. These findings warrant further studies on tDCS and experimental pain sensitivity in patients with knee osteoarthritis and exploring the magnitude and sustainability of effects on a longer term. Full article

(This article belongs to the Special Issue Challenges and Opportunities in Application of Transcranial Direct Current Stimulation (tDCS))

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17 pages, 2845 KiB

Open AccessArticle

Efficacy of Transcranial Direct Current Stimulation (tDCS) on Balance and Gait in Multiple Sclerosis Patients: A Machine Learning Approach

by Nicola Marotta, Alessandro de Sire, Cinzia Marinaro, Lucrezia Moggio, Maria Teresa Inzitari, Ilaria Russo, Anna Tasselli, Teresa Paolucci, Paola Valentino and Antonio Ammendolia

J. Clin. Med. 2022, 11(12), 3505; https://doi.org/10.3390/jcm11123505 - 17 Jun 2022

Cited by 15 | Viewed by 2514

Abstract

Transcranial direct current stimulation (tDCS) has emerged as an appealing rehabilitative approach to improve brain function, with promising data on gait and balance in people with multiple sclerosis (MS). However, single variable weights have not yet been adequately assessed. Hence, the aim of this pilot randomized controlled trial was to evaluate the tDCS effects on balance and gait in patients with MS through a machine learning approach. In this pilot randomized controlled trial (RCT), we included people with relapsing–remitting MS and an Expanded Disability Status Scale >1 and <5 that were randomly allocated to two groups—a study group, undergoing a 10-session anodal motor cortex tDCS, and a control group, undergoing a sham treatment. Both groups underwent a specific balance and gait rehabilitative program. We assessed as outcome measures the Berg Balance Scale (BBS), Fall Risk Index and timed up-and-go and 6-min-walking tests at baseline (T0), the end of intervention (T1) and 4 (T2) and 6 weeks after the intervention (T3) with an inertial motion unit. At each time point, we performed a multiple factor analysis through a machine learning approach to allow the analysis of the influence of the balance and gait variables, grouping the participants based on the results. Seventeen MS patients (aged 40.6 ± 14.4 years), 9 in the study group and 8 in the sham group, were included. We reported a significant repeated measures difference between groups for distances covered (6MWT (meters), p < 0.03). At T1, we showed a significant increase in distance (m) with a mean difference (MD) of 37.0 [−59.0, 17.0] (p = 0.003), and in BBS with a MD of 2.0 [−4.0, 3.0] (p = 0.03). At T2, these improvements did not seem to be significantly maintained; however, considering the machine learning analysis, the Silhouette Index of 0.34, with a low cluster overlap trend, confirmed the possible short-term effects (T2), even at 6 weeks. Therefore, this pilot RCT showed that tDCS may provide non-sustained improvements in gait and balance in MS patients. In this scenario, machine learning could suggest evidence of prolonged beneficial effects. Full article

(This article belongs to the Special Issue Challenges and Opportunities in Application of Transcranial Direct Current Stimulation (tDCS))

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Review

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16 pages, 580 KiB

Open AccessReview

Transcranial Direct Current Stimulation for Chronic Stroke: Is Neuroimaging the Answer to the Next Leap Forward?

by Claudia A. Salazar, Wuwei Feng, Leonardo Bonilha, Steven Kautz, Jens H. Jensen, Mark S. George and Nathan C. Rowland

J. Clin. Med. 2023, 12(7), 2601; https://doi.org/10.3390/jcm12072601 - 30 Mar 2023

Cited by 1 | Viewed by 2165

Abstract

During rehabilitation, a large proportion of stroke patients either plateau or begin to lose motor skills. By priming the motor system, transcranial direct current stimulation (tDCS) is a promising clinical adjunct that could augment the gains acquired during therapy sessions. However, the extent to which patients show improvements following tDCS is highly variable. This variability may be due to heterogeneity in regions of cortical infarct, descending motor tract injury, and/or connectivity changes, all factors that require neuroimaging for precise quantification and that affect the actual amount and location of current delivery. If the relationship between these factors and tDCS efficacy were clarified, recovery from stroke using tDCS might be become more predictable. This review provides a comprehensive summary and timeline of the development of tDCS for stroke from the viewpoint of neuroimaging. Both animal and human studies that have explored detailed aspects of anatomy, connectivity, and brain activation dynamics relevant to tDCS are discussed. Selected computational works are also included to demonstrate how sophisticated strategies for reducing variable effects of tDCS, including electric field modeling, are moving the field ever closer towards the goal of personalizing tDCS for each individual. Finally, larger and more comprehensive randomized controlled trials involving tDCS for chronic stroke recovery are underway that likely will shed light on how specific tDCS parameters, such as dose, affect stroke outcomes. The success of these collective efforts will determine whether tDCS for chronic stroke gains regulatory approval and becomes clinical practice in the future. Full article

(This article belongs to the Special Issue Challenges and Opportunities in Application of Transcranial Direct Current Stimulation (tDCS))

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12 pages, 876 KiB

Open AccessReview

Transcranial Direct Current Stimulation as an Approach to Mitigate Neurodevelopmental Disorders Affecting Excitation/Inhibition Balance: Focus on Autism Spectrum Disorder, Schizophrenia, and Attention Deficit/Hyperactivity Disorder

by Beatriz Sousa, João Martins, Miguel Castelo-Branco and Joana Gonçalves

J. Clin. Med. 2022, 11(10), 2839; https://doi.org/10.3390/jcm11102839 - 18 May 2022

Cited by 13 | Viewed by 3297

Abstract

Transcranial direct current stimulation (tDCS) has been proposed as a promising therapy for rehabilitation of neurodevelopmental disorders. In this review, we discuss studies on the impact of tDCS as a therapy for autism, schizophrenia, and attention deficit/hyperactivity disorder, as well as the tDCS’ mechanism of action, and propose future paths of research to optimize tDCS treatment protocols. The mechanism underlying tDCS effects is the modulation of excitatory and/or inhibitory activity, making it a valuable tool for restoring the excitation/inhibition (E/I) balance which is disrupted in many neurodevelopmental disorders. Clinical studies have shown that tDCS therapy is well-tolerated by patients and seems to ameliorate behavior and cognitive functions. Alterations in early development of neuronal circuits lead to disruptions in brain activity in neurodevelopmental disorders. An increasing amount of research into the effects of tDCS on neuronal activity has provided a foundation for its use as a therapy for behavior and cognitive characteristics of neurodevelopmental disorders. Clinical studies show that tDCS appears to ameliorate behavioral and cognitive outcomes of patients with autism, schizophrenia, and attention deficit/hyperactivity disorder. More research is needed to understand the mechanisms of action of tDCS and to optimize treatment protocols. Full article

(This article belongs to the Special Issue Challenges and Opportunities in Application of Transcranial Direct Current Stimulation (tDCS))

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