Electric field simulation and appropriate electrode positioning for optimized transcranial direct current stimulation of stroke patients: an in Silico model

Abstract

Transcranial Direct Current Stimulation (tDCS) has benefits for motor rehabilitation in stroke patients, but its clinical application is limited due to inter-individual heterogeneous effects. Recently, optimized tDCS that considers individual brain structure has been proposed, but the utility thereof has not been studied in detail. We explored whether optimized tDCS provides unique electrode positions for each patient and creates a higher target electric field than the conventional approach. A comparative within-subject simulation study was conducted using data collected for a randomized controlled study evaluating the effect of optimized tDCS on upper extremity function in stroke patients. Using Neurophet tES LAB 3.0 software, individual brain models were created based on magnetic resonance images and tDCS simulations were performed for each of the conventional and optimized configurations. A comparison of electrode positions between conventional tDCS and optimized tDCS was quantified by calculation of Euclidean distances. A total of 21 stroke patients were studied. Optimized tDCS produced a higher electric field in the hand motor region than conventional tDCS, with an average improvement of 20% and a maximum of 52%. The electrode montage for optimized tDCS was unique to each patient and exhibited various configurations that differed from electrode placement of conventional tDCS. Optimized tDCS afforded a higher electric field in the target of a stroke patient compared to conventional tDCS, which was made possible by appropriately positioning the electrodes. Our findings may encourage further trials on optimized tDCS for motor rehabilitation after stroke.

Past, Present, and Future of New Applications in Utilization of Eddy Currents

“…Currently, TMS has the potential to be applied to the diagnosis and treatment of types of neuronal diseases, such as depression [81][82][83], stroke [84,85], multiple sclerosis [86][87][88], and limb paralysis [89,90], without the disadvantages of electrical stimulation therapies. Eddy currents not only have been used in the development of new therapies, but also complement currently available ones.…”

“…Sekino et al [78] observed that the current distributions in the brain using TMS depend on the characteristics of the coil used. The results showed that the neurons present in the cerebellum could be activated by inducing a magnetic field of 0.56 T. Currently, TMS has the potential to be applied to the diagnosis and treatment of types of neuronal diseases, such as depression [81][82][83], stroke [84,85], multiple sclerosis [86][87][88], and limb paralysis [89,90], without the disadvantages of electrical stimulation therapies. Eddy currents not only have been used in the development of new therapies, but also complement currently available ones.…”

Simulating tDCS electrode placement to stimulate both M1 and SMA enhances motor performance and modulates cortical excitability depending on current flow direction

“…Previous studies speculated that motor-evoked potential (MEP) and cerebral blood flow changes induced by tDCS were related to EF values in the target brain area ( Mosayebi-Samani et al, 2021 ). However, conventional tDCS electrode placement in healthy controls and stroke patients often fails to induce sufficient EFs to achieve the desired effects within the targeted area ( van der Cruijsen et al, 2022 ; Yoon et al, 2024 ), making the use of electrical field simulations to optimize electrode placement a novel approach for modulating cortical excitability and enhancing motor performance in stroke patients ( van der Cruijsen et al, 2022 ).…”