CNS Non-invasive Brain Stimulation

El-Hagrassy, Mirret M.; Jones, Felipe J.S.; Rosa, Gleysson; Fregni, Felipe

doi:10.1007/978-3-319-73266-4_12

Cited by 9 publications

(12 citation statements)

References 245 publications

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“…There are unique issues concerning the safety, applicability, and ethics of tDCS application in pediatric populations which is mainly due to limited available data from children compared to the adult population [52]. However, the general safety of tDCS with standard protocols has been proven by a large body of evidence in recent years and a recent review concluded that application of conventional tDCS in human trials has not yet produced any reports of a Serious Adverse Effect or irreversible injury [107].…”

Section: Discussionmentioning

confidence: 99%

“…However, the general safety of tDCS with standard protocols has been proven by a large body of evidence in recent years and a recent review concluded that application of conventional tDCS in human trials has not yet produced any reports of a Serious Adverse Effect or irreversible injury [107]. In pediatric populations, no severe adverse events have been reported, and even in children with epilepsy, seizures do not seem to worsen with tDCS [52]. The most frequently reported side-effects within studies included in that systematic review were headache, itchiness, and redness at the site of the stimulation.…”

Section: Discussionmentioning

confidence: 99%

“…One specific concern is about current intensity due to children’s thinner skulls and the smaller distance between scalp and brain. Computational models of current flow within the brain suggest that about 50% of the current strength applied in adults result in respective effects in children [52] implicating that 0.5 mA applied in children results in similar physiological effects as 1 mA in adults [108]. From the studies included in this meta-analysis, eight studies applied a current intensity of 1 mA or lower, two studies applied 1.5 mA and one study applied 2 mA, and no significant adverse effect was reported (See Tables 1 & 2).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, most clinical tDCS studies so far have focused on adult populations and there is a great need for more research into their therapeutic uses in pediatric patients [49, 50]. Considering the fact that pediatric brains still have to go through various stages of neurodevelopment and have accelerated neuroplasticity compared to adults [51], tDCS could be considered a potential therapy for some pediatric disorders, particularly when there are no other safe viable alternatives [52]. That being said, knowledge about tDCS effects in ADHD, is still relatively limited and warrants further investigation especially through systematic review or meta-analytic studies.…”

Section: Introductionmentioning

confidence: 99%

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Transcranial direct current stimulation in attention-deficit hyperactivity disorder: A meta-analysis of neuropsychological deficits

et al. 2019

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Transcranial direct current stimulation (tDCS) is a promising method for altering cortical excitability with clinical implications in neuropsychiatric diseases. Its application in neurodevelopmental disorders especially attention-deficit hyperactivity disorder (ADHD), is in early stage and promising but its effectiveness has not been systematically examined yet. We conducted a meta-analysis on the effectiveness of tDCS on the most studied neuropsychological symptoms of ADHD, which is the first reported meta-analysis of tDCS studies on ADHD. Data from 10 randomized controlled studies (including 11 separate experiments) targeting inhibitory control, and/or working memory (WM) in ADHD were included. Results show that overall tDCS significantly improved inhibitory control. Sub-analyses further show that dorsolateral prefrontal cortex (dlPFC) (but not right inferior frontal gyrus) tDCS and anodal (but not cathodal) tDCS significantly improved inhibitory control with a small effect size. Anodal dlPFC-tDCS had the largest significant effect on inhibitory control with a small-to-medium effect size. Additionally, a significant improving effect of tDCS on inhibitory control accuracy (but not response time) and WM speed (but not accuracy) were found. Overall, this meta-analysis supports a beneficial effect of tDCS on inhibitory control and WM in ADHD with a small-to-medium effect size. TDCS seems to be a promising method for improving neuropsychological and cognitive deficits in ADHD. However, there might be a dissociation between neuropsychological deficits and clinical symptoms of ADHD and therefore, the significance of this meta-analysis for clinical purposes is limited. Future studies should systematically evaluate the role of inter-individual factors (i.e., ADHD subtype, types of the deficit) and stimulation parameters (i.e., site, polarity, intensity, duration, repetition rate) on tDCS efficacy in ADHD population and examine whether benefits are long-term.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transcranial direct current stimulation in attention-deficit hyperactivity disorder: A meta-analysis of neuropsychological deficits

et al. 2019

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“…For example, online anodal stimulation (with somewhat unusual parameters) of ipsilesional leg M1 in mostly subcortical strokes improved an ankle-tracking task, while anodal contralesional leg M1 stimulation had a detrimental effect on learning ( Madhavan et al, 2011 ). In a negative trial on contralesional cathodal stimulation within a month of stroke, one-half of the participants’ corticospinal tracts may have been too damaged to modulate, and using a right shoulder reference may have reduced current flow to the left M1 that was damaged in one-half of the patients ( Fusco et al, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders

Fregni

El-Hagrassy

Pacheco‐Barrios

et al. 2020

International Journal of Neuropsychopharmacology

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Background Transcranial direct current stimulation (tDCS) has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects. Objective We convened a team of tDCS experts to conduct a systematic review of clinical trials with more than one session of stimulation testing: Pain, Parkinson’s Disease Motor Function and Cognition, Stroke Motor Function and Language, Epilepsy, Major Depressive Disorder, Obsessive-Compulsive Disorder, Tourette Syndrome, Schizophrenia and Drug Addiction. Methods Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into: Levels A (definitely effective), B (probably effective), C (possibly effective) or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies. Results Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A) such as depression, probably effective (Level B) such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson´s disease (motor and cognition), stroke (motor), epilepsy, schizophrenia and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with largest effect size being in postoperative acute pain, and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy). Conclusion All recommendations listed here are based on current published Pubmed-indexed data. Despite high level of evidence in some conditions, it needs to be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.

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Male and Female Physician Suicidality

et al. 2020

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IMPORTANCE Population-based findings on physician suicide are of great relevance because this is an important and understudied topic.OBJECTIVE To evaluate male and female physician suicide risks compared with the general population from 1980 to date and test whether there is a reduction of SMR in cohorts after 1980 compared with before 1980 via a meta-analysis, modeling studies, and a systematic review emphasizing physician suicide risk factors.DATA SOURCES This study uses studies retrieved from PubMed, Scielo, PsycINFO, and Lilacs for human studies published by October 3, 2019, using the search term "(((suicide) OR (self-harm) OR (suicidality)) AND ((physicians) OR (doctors)))." Databases were also searched from countries listed in articles selected for review. Data were also extracted from an existing article by other authors to facilitate comparisons of the pre-1980 suicide rate with the post-1980 changes.STUDY SELECTION Original articles assessing male and/or female physician suicide were included; for the meta-analysis, only cohorts from 1980 to the present were included. DATA EXTRACTION AND SYNTHESISThe preregistered systematic review and meta-analysis followed Cochrane, PRISMA, and MOOSE guidelines. Data were extracted into standardized tables per a prespecified structured checklist, and quality scores were added. Heterogeneity was tested via Q test, I 2 , and τ 2 . For pooled effect estimates, we used random-effects models. The Begg and Egger tests, sensitivity analyses, and meta-regression were performed. Proportional mortality ratios were presented when SMR data could not be extracted. MAIN OUTCOMES AND MEASURESSuicide SMRs for male and female physicians from 1980 to the present and changes over time (before and after 1980). RESULTSOf 7877 search results, 32 articles were included in the systematic review and 9 articles and data sets in the meta-analysis. Meta-analysis showed a significantly higher suicide SMR in female physicians compared with women in general (1.46 [95% CI,) and a significantly lower suicide SMR in male physicians compared with men in general (0.67 [95% CI, 0.55-0.79]). Male and female physician SMRs significantly decreased after 1980 vs before 1980 (male physicians: SMR, −0.84 [95% CI, −1.26 to −0.42]; P < .001; female physicians: SMR, −1.96 [95% CI, −3.09 to −0.84]; P = .002). No evidence of publication bias was found.CONCLUSIONS AND RELEVANCE In this study, suicide SMR was found to be high in female physicians and low in male physicians since 1980 but also to have decreased over time in both groups. Physician suicides are multifactorial, and further research into these factors is critical.

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CNS Non-invasive Brain Stimulation

Cited by 9 publications

References 245 publications

Transcranial direct current stimulation in attention-deficit hyperactivity disorder: A meta-analysis of neuropsychological deficits

Transcranial direct current stimulation in attention-deficit hyperactivity disorder: A meta-analysis of neuropsychological deficits

Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders

Male and Female Physician Suicidality

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