Search Results (506)

Background/Objectives: Neck pain caused by myofascial pain syndrome (MPS) is a highly prevalent musculoskeletal condition. Repetitive peripheral magnetic stimulation (rPMS) is a promising treatment option; however, its therapeutic effect and optimal treatment frequency remain unclear. This study aimed to investigate the therapeutic effect and duration of effect of rPMS in patients with MPS of the neck. Methods: In this randomized, sham-controlled, crossover trial, 27 patients with neck MPS and baseline visual analog scale (VAS) scores ≥ 40 were enrolled. The mean age was 43.8 ± 9.1 years, and 63% were female. Participants were randomly assigned to receive either an initial rPMS treatment (a 10 min session delivering 3900 pulses at 5–10 Hz) or sham stimulation. After 7 days, groups crossed over. Pain intensity (VAS), disability (Neck Disability Index; NDI), and analgesic use were recorded daily for seven consecutive days. A linear mixed-effects model was used for analysis. Results: At baseline, the VAS and NDI scores were 61.8 ± 10.5 and 26.0 ± 6.3, respectively. rPMS produced a significantly greater reduction in both VAS and NDI scores, with the greatest differences observed on Day 4: the differences were −24.1 points in VAS and −8.5 points in NDI compared to the sham group. There was no significant difference in analgesic use between the two groups. Conclusions: A single rPMS session provides short-term improvement in pain and disability in neck MPS. Based on the observed therapeutic window, more frequent sessions (e.g., twice weekly) may provide sustained benefit and should be explored in future studies. Full article

The objective of this study was to investigate the temporal effectiveness of repetitive peripheral magnetic stimulation (rPMS) on lower-limb motor skill performance in individuals with chronic stroke. In this sham-controlled crossover study, we hypothesized that individuals with stroke who received rPMS would demonstrate improved motor skill performance after the stimulation and maintain this enhanced performance at 30 and 60 min after the stimulation. Sixteen participants performed a visuomotor ankle-tracking task at multiple time points following either rPMS or sham stimulation. rPMS, delivered to the tibialis anterior muscle, did not result in statistically significant changes in spatiotemporal (p = 0.725) or spatial error (p = 0.566) metrics at any post-stimulation time point. These findings suggest that a single session of rPMS does not lead to measurable improvements in lower-limb motor skill performance in individuals with stroke, underscoring the need to refine stimulation parameters and target populations in future protocols. Full article

This study investigates the effects of transcutaneous electroacupuncture stimulation (TEAS) on eyeblink rate, EEG, and heart rate variability (HRV), emphasising whether eyeblink data—often dismissed as artefacts—can serve as useful physiological markers. Sixty-six participants underwent four TEAS sessions with different stimulation frequencies (2.5, 10, 80, and 160 pps, with 160 pps as a low-amplitude sham). EEG, ECG, PPG, and respiration data were recorded before, during, and after stimulation. Using non-parametric statistical analyses, including Friedman’s test, Wilcoxon, Conover–Iman, and bootstrapping, the study found significant changes across eyeblink, EEG, and HRV measures. Eyeblink laterality, particularly at 2.5 and 10 pps, showed strong frequency-specific effects. EEG power asymmetry and spectral centroids were associated with HRV indices, and 2.5 pps stimulation produced the strongest parasympathetic HRV response. Blink rate correlated with increased sympathetic and decreased parasympathetic activity. Baseline HRV measures, such as lower heart rate, predicted participant dropout. Eyeblinks were analysed using BLINKER software (v. 1.1.0), and additional complexity and entropy (‘CEPS-BLINKER’) metrics were derived. These measures were more predictive of adverse reactions than EEG-derived indices. Overall, TEAS modulates multiple physiological markers in a frequency-specific manner. Eyeblink characteristics, especially laterality, may offer valuable insights into autonomic function and TEAS efficacy in neuromodulation research. Full article

Background/Objectives: Anorexia nervosa (AN) is a severe disorder with limited treatment efficacy. This interim analysis aimed to assess the preliminary efficacy and safety of transcranial direct current stimulation (tDCS) in reducing core AN symptoms, stress, depression, low self-esteem, and BMI in adolescent females, to determine the rationale for continuing the study. Methods: A single-center, randomized, double-blind, placebo-controlled trial included 20 adolescent females with AN assigned to an active tDCS group (n = 10) or a sham group (n = 10). The intervention involved 30 sessions over three weeks, targeting the dorsolateral prefrontal cortex. Outcomes were assessed at baseline, post-treatment, and follow-up using the Eating Attitudes Test (EAT-26) for eating disorder symptoms, the Perceived Stress Scale (PSS-10) for stress, the Beck Depression Inventory (BDI) for depression, the Rosenberg Self-Esteem Scale (SES) for self-esteem, and body mass index (BMI) measurements. Safety and tolerability were assessed using the tDCS Side Effects Questionnaire. Results: Eating disorder symptoms significantly decreased in the active tDCS group at study end (p = 0.003) and follow-up (p = 0.02), while no significant changes were observed in the sham group. Although BMI increased more in the active group (13.78%) than in the sham group (7.31%), this difference was not statistically significant (p = 0.10). Conclusions: Adverse effects were mild and transient, with no serious safety concerns reported. Based on the results of this interim analysis, the study will proceed due to promising efficacy outcomes and good treatment tolerability. Full article

Transcranial direct current stimulation (tDCS) modulates cortical excitability, thus inducing improvements in motor learning of simple tasks. In this study, we aimed to evaluate the effect of different tDCS conditions—anodal stimulation over the motor cortex (M1), anodal and cathodal stimulation over the prefrontal cortex (PFC), and sham—on the online and offline learning of a complex accuracy task (golf-putting) in novice golfers. Methods: A total of 40 young, healthy subjects (24 men, 16 women) without previous golf experience were randomly distributed in four groups receiving sham, anodal M1, anodal PFC or cathodal PFC tDCS. All subjects participated in two consecutive sessions. In the first session, they performed 15 blocks of 10 golf-putting along with tDCS stimulation. After 24 h, they performed the same task without tDCS. Results: Repeated measures ANOVA revealed a significant improvement in performance during the two consecutive golf-putting sessions regardless of the site and the stimulation conditions. Conclusion: Our findings suggest that tDCS over M1 or PFC does not confer additional benefits in the acquisition of complex, full-body motor skills such as golf-putting. Full article

Background: Parkinson’s disease (PD) presents a significant challenge due to its wide range of motor, non-motor, and treatment-related symptoms. Non-invasive interventions like transcranial magnetic stimulation (TMS) are being explored for potential therapeutic benefits. This study aimed to assess if a high-frequency repetitive TMS protocol (HF-rTMS) consisting of 10 trains of 100 pulses of rTMS at 25 Hz over the motor cortex (M1) at 80% of the resting motor threshold could be effective in treating motor or non-motor symptoms in patients with PD with levodopa-induced dyskinesias. Methods: A randomized, single-blinded, placebo-controlled pilot trial was conducted with eleven PD patients. Nine patients received HF-rTMS, while two received sham stimulation. Patients were exhaustively evaluated using validated clinical scales to assess motor and non-motor symptoms. The study followed a rigorous protocol to avoid bias, with assessments conducted by a neurologist specialized in single-blinded movement disorder. Results: The HF-rTMS group experienced a statistically significant slight worsening in both motor and non-motor symptoms, particularly in the mood/cognition and gastrointestinal domains. However, positive effects were observed in some non-motor symptoms, specifically reduced excessive sweating and weight. No adverse effects were reported. Conclusions: Although HF-rTMS did not produce significant motor improvements, its potential benefit on specific non-motor symptoms, such as autonomic regulation, warrants further investigation. Full article

Background/Objectives: We showed that a tailored strengthening intervention based on the size of motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) in the affected hemisphere resulted in an improved affected arm function, regardless of stroke severity. Also, adding anodal transcranial direct stimulation (atDCS) during training did not alter the results as participants receiving real or sham stimulation showed similar gains. The goal of this study was to report on the changes in basic measures of corticomotor excitability in response to the intervention and to determine whether these changes were influenced by tDCS and correlated with those measured in arm function. Methods: The TMS measures consisted of the resting motor threshold (rMT), MEP amplitude at rest, and the silent period (SP) duration. Clinical outcomes included the Box and Block test (BBT) and grip strength (GS). Results: Post-intervention, regardless of atDCS (p > 0.62), no significant change in corticomotor excitability was noted (p > 0.15), as well as no association between the changes in TMS measures and arm function gains (p > 0.06). Conclusions: As observed for clinical measures, atDCS did not influence corticomotor excitability. The absence of an increase in the excitability of the affected hemisphere and important associations between changes in corticomotor excitability and clinical gains suggest that factors other than brain plasticity could mediate gains in arm function. Further investigations are required regarding the role of tDCS in stroke rehabilitation. Full article

Background: Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique for migraine prevention. This study evaluates the efficacy of tDCS compared to sham in preventing episodic migraine in adults. Methods: PubMed and Embase databases were searched until May 2025 to identify randomized controlled trials comparing tDCS with sham for the prevention of episodic migraine in adults. Risk of bias in the included trials was assessed using the Cochrane Risk of Bias Tool version 2. A random effect meta-analysis was conducted to evaluate the effects of cathodal and anodal tDCS on migraine frequency (days per month and attacks per month). Results: The meta-analysis included six trials with 172 participants (mean age 34 years, 82% females). Both cathodal (three studies, over the occipital area) and anodal (three studies, over the occipital or primary motor area) tDCS reduced the mean number of monthly migraine days and migraine attacks compared to sham. After pooling the outcomes and excluding two studies at high risk of bias, anodal tDCS over the occipital or primary motor area (standardized difference in means = −0.7, 95% CI: −1.7, 0.2, p = 0.124) and cathodal tDCS over the occipital area (standardized difference in means = −0.7, 95% CI: −1.1, −0.3, p = 0.000) reduced headache frequency compared to sham. However, the reduction with anodal tDCS was not statistically significant. Summary: tDCS may be effective in preventing episodic migraine. However, the evidence is limited by the small number of heterogeneous trials, with variation in electrode placement and stimulation intervals. Full article

Background: Metacognition refers to the ability to reflect on and regulate cognitive processes. Despite advances in neuroimaging and lesion studies, its neural correlates, as well as their interplay with other cognitive domains, remain poorly understood. The orbitofrontal cortex (OFC) is proposed as a potential substrate for metacognitive processing due to its contribution to evaluating and integrating reward-related information, decision-making, and self-monitoring. Methods: This study examined OFC involvement in metacognition using transcranial direct current stimulation (tDCS) while participants performed a two-alternative forced choice task with confidence ratings to assess their metacognitive sensitivity. Before stimulation, the subjects completed the Metacognitions Questionnaire-30 and a monetary intertemporal choice task for the quantification of delay discounting. Results: Linear mixed-effects models showed that anodal tDCS over the left OFC reduced participants’ metacognitive sensitivity compared to sham stimulation, leaving perceptual decision-making accuracy unaffected. Moreover, real stimulation increased self-reported confidence ratings compared to the sham. Significant correlations were found between metacognitive sensitivity and negative beliefs about thinking. Conclusions: These results highlight the potential involvement of the OFC in the processing of retrospective second-order judgments about decision-making performance. Additionally, they support the notion that OFC overstimulation contributes to metacognitive dysfunctions detected in clinical conditions, such as difficulties in assessing the reliability of one’s thoughts and decision outcomes. Full article

Background: Previous studies have indicated that transcutaneous electrical nerve stimulation (TENS) is highly effective in improving the treatment of neuropathy and achieving maximum recovery in the shortest time. However, its effectiveness in the early stages of the disease has not been studied, and no comparative analysis has been conducted between different modalities of TENS. Materials and Methods: This study included 82 patients with acute and subacute fibular tunnel (FT) syndrome lasting no more than 15 days. Patients were randomized into the following four groups depending on the modality of TENS used: sham TENS (20 patients), HF TENS (20 patients), LF TENS (21 patients), and a combined HF/LF TENS group (21 patients). Before treatment, immediately after treatment, and 3 months after the end of treatment patients were examined to determine the severity of hypoesthesia, motor deficit, and gait disturbance. Results: The reduction in hypoesthesia averaged after HF TENS, LF TENS, and sham TENS was 50.7% (p ≤ 0.01), 37.8 (p ≤ 0.01), and 11.4% (p > 0.05), respectively. The regression of motor deficit and gate disorders reached 61% after LF TENS (p ≤ 0.01), 6% after HF TENS (p > 0.05), and 6% (p > 0.05) after sham TENS. The combination of HF and LF TENS resulted in a 54.8% (p ≤ 0.01) reduction in hypoesthesia and 61.3% (p ≤ 0.01) regression of motor deficit, with a superior 30% (p ≤ 0.05) improvement in quality of life compared to separate use of HF and LF TENS. Conclusions: Early use of TENS in the treatment of FT syndrome turned out to be highly effective compared to sham TENS in reducing hypoesthesia, motor deficit, and gait disturbance. The analgesic effect and sensory recovery were higher after HF TENS. Motor and gait disturbances were reduced only after LF TENS, with evidence of prolonged regenerative and protective effect for at least 3 months after the end of treatment. The combination of HF TENS and LF TENS increases the therapeutic range of TENS with the achievement of the maximum positive effect of HF TENS and LF TENS after treatment and during the long-term period, which leads to a more pronounced improvement in the quality of life of patients with this pathology. Full article

Background: Lower limb motor output contributes to determining functional performance in many motor tasks. This study investigated the effects of non-invasive spinal cord transcutaneous stimulation (scTS) applied during an exercise-based priming protocol on lower limb muscle force and power generation. Methods: Twelve young, physically active male volunteers (age: 22.7 ± 2.1 years) participated in this randomized crossover, sham-controlled study. The maximal voluntary contraction and low-level torque steadiness of knee extensors, as well as the maximal explosive extension of lower limbs, were assessed before and after the priming protocol with scTS or sham stimulation over a total of four experimental sessions. Further, characteristics of evoked potentials to scTS related to spinal circuitry excitability were assessed in the supine position before and after the scTS priming protocol. The exercise component of the ~25 min priming protocol consisted of low-volume, low- and high-intensity lower limb motor tasks. Results: scTS priming protocol tended to increase or maintain maximum isometric torque during knee extension (4.7%) as well as peak force (0.2%) and rate of force development (6.0%) during explosive lower limb extensions, whereas sham priming protocol tended to decrease them (−4.3%, −3.3%, and −15.1%, respectively). This resulted in significant interactions (p = 0.001 to 0.018) and medium–large differences between scTS and sham protocols. These findings were associated with meaningful trends of some neurophysiological variables. Conversely, priming protocols did not affect low-level torque steadiness. Conclusions: scTS counteracted the unexpected fatigue induced by the exercise-based priming protocol, supporting lower limb performance during maximal efforts. Future studies are warranted to assess the implementation of scTS with optimized exercise-based priming protocols during training and rehabilitation programmes that include high-intensity neuromuscular efforts. Full article

Background: Chronic shoulder pain is a prevalent musculoskeletal disorder often associated with central sensitisation, which limits the effectiveness of conventional therapies. Transcranial direct current stimulation (tDCS) has emerged as a non-invasive neuromodulatory intervention to modulate cortical excitability and potentially improve pain and functional outcomes. Methods: This scoping review followed the Joanna Briggs Institute (JBI) framework and PRISMA-ScR guidelines. A systematic search was conducted across MEDLINE, CENTRAL, Scopus, PEDro, and Web of Science to identify studies evaluating the effects of tDCS on pain and function in adults with rotator cuff disorders, myofascial pain syndrome (MPS), or subacromial pain syndrome (SAPS). Data were extracted and synthesised qualitatively. Results: Four studies met the inclusion criteria. tDCS demonstrated variable efficacy: some trials reported no additional benefit when used alongside corticosteroid injections or sensorimotor training (e.g., SAPS and rotator cuff tendinopathy), while others showed enhanced pain reduction and functional gains, particularly in MPS. Targeting the dorsolateral prefrontal cortex (DLPFC) appeared more effective than stimulating the primary motor cortex (M1) in modulating pain. Functional improvements were generally observed, though not consistently superior to sham interventions. Conclusions: Preliminary evidence suggests that tDCS may represent a promising adjunctive treatment for chronic shoulder pain, particularly in MPS. However, due to the limited number of studies and heterogeneity in methods, conclusions should be interpreted with caution. However, heterogeneity in study protocols, stimulation targets, and patient populations limits conclusive recommendations. Standardised protocols and larger trials are needed to determine the optimal application of tDCS in clinical shoulder pain management. Full article

Background: Working memory (WM) is a critical component of cognitive performance. Although transcranial direct current stimulation (tDCS) is a promising neuromodulation technique, its effect on working memory in healthy individuals remains unclear. Methods: In this study, EEG signals were recorded from different groups (working memory group, tDCS group, and sham group) and analyzed using phase–amplitude coupling, power spectral density, and brain network analysis to investigate the effect and mechanism of tDCS on working memory tasks in healthy individuals. Results: The results showed that in the tDCS group, the power spectral density of the EEG was increased in the gamma band and decreased in the delta band, while the delta–gamma phase–amplitude coupling was also decreased during the working memory task. Meanwhile, brain network analysis indicated significant differences in the node degree and clustering coefficient between the active and sham stimuli. Conclusions: Despite the absence of immediate behavioral improvements, these results suggest that tDCS could significantly modulate working memory-related EEG activity. Full article

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. Full article

Background/Objectives: Chronic attention problems occur in approximately 25% of children after acquired brain injury (ABI). When delivered daily, transcranial direct current stimulation (tDCS) may improve attention; however, access to daily in-clinic tDCS treatment can be limited by other commitments, including concurrent therapy, school commitments, and caregiver schedules. Treatment access can be improved through home-based interventions, though these require several practical and safety considerations in a pediatric ABI population. This study evaluated the safety, feasibility, and tolerability of remotely monitored at-home tDCS during online gamified attention training in pediatric ABI. Methods: We conducted a randomized, single-blind, dose-controlled clinical trial of at home tDCS in Brisbane, Australia (10 tDCS sessions; 20 min; 1 mA or 2 mA; bilateral dorsolateral prefrontal cortex). Participants attended our clinic at baseline for clinical assessments, fitting of the personalized tDCS headband, and training in how to use tDCS at home. All sessions were remotely supervised using live videoconferencing. We assessed the feasibility and tolerability of at-home tDCS and our customized, personalized at-home tDCS headband as primary outcomes. As secondary outcomes, we evaluated changes in functional connectivity (fc) and reaction time (RT). Results: Seventy-three participants were contacted over six months (January-June 2023) and ten were enrolled (5 males; mean age: 12.10 y [SD: 2.9]), satisfying a priori recruitment timelines (CONSORT reporting). All families successfully set up tDCS and completed attention training with excellent protocol adherence. There were no serious adverse events over the 100 total sessions. Nine participants completed all stimulation sessions (1 mA: n = 5, 2 mA: n = 4). Participants in the 2 mA group reported greater tingling, itching, and discomfort (all p < 0.05). One participant in the 1 mA group was unable to complete all sessions due to tolerability challenges; however, these challenges were resolved in the second half of the intervention by gradually increasing the stimulation duration across the 10 days alongside additional coaching and support. Conclusions: Overall, daily remotely supervised at-home tDCS in patients with pediatric ABI is safe, feasible, and tolerable. Our results support larger, sham-controlled efficacy trials and provide a foundation for the development of safe and effective at-home stimulation therapeutics that may offer targeted improvement of neurocognitive symptoms in children. Full article