Tolerability and feasibility of at-home remotely supervised transcranial direct current stimulation (RS-tDCS): Single-center evidence from 6,779 sessions

Pilloni, Giuseppina; Vogel-Eyny, Amy; Lustberg, Matthew; Best, Pamela; Malík, Martin; Walton-Masters, Lillian; George, Allan; Mirza, Ibraheem; Zhovtis, Lana; Datta, Abhishek; Bikson, Marom; Krupp, Lauren; Charvet, Leigh

doi:10.1016/j.brs.2022.04.014

Cited by 45 publications

(37 citation statements)

References 40 publications

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“…A second goal of this study was to derive a new, efficient tDCS stimulation strategy based on simple EEG coordinates. Since tDCS is uniquely appealing for its ease of use and ability to be self-administered in an at-home environment 18 – 22 , it is important to consider how easy it would be to implement new tDCS electrode positioning strategies. Taking this into consideration, we sought to develop a straightforward, easily replicable tDCS approach relying on 10–10 EEG coordinates as opposed to MRI-based individualized dosing or electrode positioning.…”

Section: Discussionmentioning

confidence: 99%

“…By passing small uniform electrical currents of 1 or 2 mA through anodal and cathodal scalp electrodes, tDCS can open sodium-dependent ion channels in underlying neurons 12 , increasing intracellular calcium concentration 13 , 14 and driving long term potentiation (LTP) 15 . However, despite widespread interest in tDCS and appeal due to its noninvasive 16 , inexpensive 17 , and easily disseminatable nature with potential at-home use 18 – 22 , there are inconsistent effects of stimulation 23 – 28 and no FDA-approved indication for tDCS to date.…”

Section: Introductionmentioning

confidence: 99%

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Optimized APPS-tDCS electrode position, size, and distance doubles the on-target stimulation magnitude in 3000 electric field models

Caulfield

George

2022

Sci Rep

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Transcranial direct current stimulation (tDCS) is a widely used noninvasive brain stimulation technique with mixed results to date. A potential solution is to apply more efficient stimulation to ensure that each participant receives sufficient cortical activation. In this four-part study, we used electric field (E-field) modeling to systematically investigate the cortical effects of conventional and novel tDCS electrode montages, with the goal of creating a new easily adoptable form of tDCS that induces higher and more focal E-fields. We computed 3000 anatomically accurate, MRI-based E-field models using 2 mA tDCS to target the left primary motor cortex in 200 Human Connectome Project (HCP) participants and tested the effects of: 1. Novel Electrode Position, 2. Electrode Size, and 3. Inter-Electrode Distance on E-field magnitude and focality. In particular, we examined the effects of placing electrodes surrounding the corticomotor target in the anterior and posterior direction (anterior posterior pad surround tDCS; APPS-tDCS). We found that electrode position, electrode size, and inter-electrode distance all significantly impact the cortical E-field magnitude and focality of stimulation (all p < 0.0001). At the same 2 mA scalp stimulation intensity, APPS-tDCS with smaller than conventional 1 × 1 cm electrodes surrounding the neural target deliver more than double the on-target cortical E-field (APPS-tDCS: average of 0.55 V/m from 2 mA; M1-SO and bilateral M1: both 0.27 V/m from 2 mA) while stimulating only a fraction of the off-target brain regions; 2 mA optimized APPS-tDCS produces 4.08 mA-like cortical E-fields. In sum, this new optimized APPS-tDCS method produces much stronger cortical stimulation intensities at the same 2 mA scalp intensity. APPS-tDCS also more focally stimulates the cortex at the intended target, using simple EEG coordinate locations and without MRI scans. This APPS-tDCS method is adoptable to any existing, commercially available tDCS device and can be used to ensure sufficient cortical activation in each person. Future directions include testing whether APPS-tDCS produces larger and more consistent therapeutic tDCS effects.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimized APPS-tDCS electrode position, size, and distance doubles the on-target stimulation magnitude in 3000 electric field models

Caulfield

George

2022

Sci Rep

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“…13 Dysphagia is associated with serious respiratory consequences such as an increased risk of poststroke pneumonia. 11 Biofeedback from surface electromyography has been shown to improve swallowing outcomes in poststroke dysphagia. 14 Methods to remotely monitor swallowing function, including dysphagia, are in early development.…”

Section: Dysphagiamentioning

confidence: 99%

“…Given their complexity in administration, these treatments are typically delivered in person. One group recently evaluated the delivery of transcranial direct current stimulation over videoconference to neurological patients 11 that serves as a model for delivering complex, technology-based interventions remotely. They incorporated extensive safety mechanisms: devices were preprogrammed; the staff provided a code to the participant at each virtual session to unlock the device; the electrode contact quality was shown in real time; a beep would sound if the contact quality was not sufficient; and every session ended with a screen capture querying adverse events.…”

Section: Neuromodulationmentioning

confidence: 99%

Advances in Remote Monitoring for Stroke Recovery

Eng

Pastva

2022

Stroke

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“…Recent technological advances led to more effective and tolerable, non-invasive brain stimulation methods that can be safely applied to the cerebellum ( 22 , 23 ). Consequently, there has been exponential growth in studies using the methods depicted in Figure 1 such as repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and transcranial pulsed current stimulation (tPCS).…”

Section: Introductionmentioning

confidence: 99%

Cerebellar stimulation in schizophrenia: A systematic review of the evidence and an overview of the methods

2022

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BackgroundCerebellar structural and functional abnormalities underlie widespread deficits in clinical, cognitive, and motor functioning that are observed in schizophrenia. Consequently, the cerebellum is a promising target for novel schizophrenia treatments. Here we conducted an updated systematic review examining the literature on cerebellar stimulation efficacy and tolerability for mitigating symptoms of schizophrenia. We discuss the purported mechanisms of cerebellar stimulation, current methods for implementing stimulation, and future directions of cerebellar stimulation for intervention development with this population.MethodsTwo independent authors identified 20 published studies (7 randomized controlled trials, 7 open-label studies, 1 pilot study, 4 case reports, 1 preclinical study) that describe the effects of cerebellar circuitry modulation in patients with schizophrenia or animal models of psychosis. Published studies up to October 11, 2022 were identified from a search within PubMed, Scopus, and PsycInfo.ResultsMost studies stimulating the cerebellum used transcranial magnetic stimulation or transcranial direct-current stimulation, specifically targeting the cerebellar vermis/midline. Accounting for levels of methodological rigor across studies, these studies detected post-cerebellar modulation in schizophrenia as indicated by the alleviation of certain clinical symptoms (mainly negative and depressive symptoms), as well as increased frontal-cerebellar connectivity and augmentation of canonical neuro-oscillations known to be abnormal in schizophrenia. In contrast to a prior review, we did not find consistent evidence for cognitive improvements following cerebellar modulation stimulation. Modern cerebellar stimulation methods appear tolerable for individuals with schizophrenia, with only mild and temporary side effects.ConclusionCerebellar stimulation is a promising intervention for individuals with schizophrenia that may be more relevant to some symptom domains than others. Initial results highlight the need for continued research using more methodologically rigorous designs, such as additional longitudinal and randomized controlled trials.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022346667].

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Tolerability and feasibility of at-home remotely supervised transcranial direct current stimulation (RS-tDCS): Single-center evidence from 6,779 sessions

Cited by 45 publications

References 40 publications

Optimized APPS-tDCS electrode position, size, and distance doubles the on-target stimulation magnitude in 3000 electric field models

Optimized APPS-tDCS electrode position, size, and distance doubles the on-target stimulation magnitude in 3000 electric field models

Advances in Remote Monitoring for Stroke Recovery

Cerebellar stimulation in schizophrenia: A systematic review of the evidence and an overview of the methods

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