121 results on '"Paulus, Walter"'
Search Results
2. Contributors
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Abel, E. Dale, primary, Adamo, Luigi, additional, Ali, Shah R., additional, Allen, Larry A., additional, Bakris, George L., additional, Bloomfield, Gerald S., additional, Bonow, Robert O., additional, Bozkurt, Biykem, additional, Bristow, Michael R., additional, Brown, Angela L., additional, Bugger, Heiko, additional, Burnett, John C., additional, Butler, Javed, additional, Carroll, John D., additional, Castaño, Adam, additional, Chang, Anna Marie, additional, Cohn, Jay N., additional, Colucci, Wilson S., additional, Dell’Italia, Louis J., additional, Deswal, Anita, additional, DeVore, Adam D., additional, Diwan, Abhinav, additional, DuBrock, Hilary M., additional, Dunlay, Shannon M., additional, Dzhoyashvili, Nina, additional, Ewald, Gregory A., additional, Ezekowitz, Justin A., additional, Fang, James C., additional, Fedson, Savitri, additional, Feinstein, Matthew J., additional, Felker, G. Michael, additional, Ferguson, John D., additional, Ferrari, Victor A., additional, Ferrario, Carlos M., additional, Flaherty, James D., additional, Floras, John S., additional, Florea, Viorel G., additional, Gaggin, Hanna K., additional, Greenberg, Barry, additional, Hare, Joshua M., additional, Hernandez, Adrian F., additional, Hill, Joseph A., additional, Ibrahim, Nasrien E., additional, Januzzi, James L., additional, Joseph, Susan M., additional, Judge, Daniel P., additional, Kahn, Andrew M., additional, Kalogeropoulos, Andreas P., additional, Kass, David A., additional, Keaney, John, additional, Khan, Ahsan A., additional, Kim, Paul J., additional, Kobashigawa, Jon A., additional, Kransdorf, Evan P., additional, Krieger, Eric V., additional, Lam, Nicholas T., additional, Lenihan, Daniel J., additional, Lip, Gregory Y.H., additional, Longenecker, Chris T., additional, MacLellan, W. Robb, additional, Mann, Douglas L., additional, Marian, Ali J., additional, Matlock, Daniel D., additional, Maurer, Mathew S., additional, McNamara, Dennis M., additional, Mentz, Robert J., additional, Metra, Marco, additional, Milano, Carmelo A., additional, Misra, Arunima, additional, Mitchell, Joshua D., additional, Morrison, Alan R., additional, Nabeebaccus, Adam, additional, Nakamura, Kenta, additional, Nativi-Nicolau, Jose, additional, Ngo, Doan T.M., additional, Oatmen, Kelsie E., additional, Pang, Peter S., additional, Papadimitriou, Lampros, additional, Paulus, Walter J., additional, Polonsky, Tamar S., additional, Port, J. David, additional, Rader, Florian, additional, Ragupathi, Loheetha, additional, Redfield, Margaret M., additional, Rich, Michael W., additional, Rogers, Joseph G., additional, Ryan, John J., additional, Sadek, Hesham A., additional, Sag, Can Martin, additional, Sapp, Ashley A., additional, Sawyer, Douglas B., additional, Schulze, P. Christian, additional, Shah, Ajay M., additional, Shantsila, Eduard, additional, Singh, Jagmeet P., additional, Sinusas, Albert J., additional, Sliwa, Karen, additional, Spinale, Francis G., additional, Stewart, Simon, additional, Sucharov, Carmen, additional, John Sutton, Martin St., additional, Sverdlov, Aaron L., additional, Toth, Michael J., additional, Valente, Anne Marie, additional, van Heerebeek, Loek, additional, Varagic, Jasmina, additional, Victor, Ronald G., additional, Webb, Ian, additional, Wende, Adam R., additional, Whellan, David, additional, and Wiktor, Dominik M., additional
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- 2020
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3. Pharmacological treatments of augmentation in restless legs syndrome patients
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Trenkwalder, Claudia, primary and Paulus, Walter, additional
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- 2019
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4. Needle EMG induced muscle bleeding complication after guideline approved discontinuation of anticoagulation
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Bartl, Michael, Krahn, Arne, Riggert, Joachim, and Paulus, Walter
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body regions ,Anticoagulation ,Electromyography ,Bleeding ,Case Report ,Neurosciences. Biological psychiatry. Neuropsychiatry ,Non-steroidal anti-inflammatory drugs ,RC321-571 - Abstract
Highlights • After needle EMG an intramuscular hematoma, requiring surgical evacuation, occurred. • Anticoagulation was paused according to guidelines; one patient had an undetected genetic disorder of platelet function. • Substituting apixaban for enoxaparin may have contributed to the complications., Introduction Needle electromyography (EMG) is an essential part of electrodiagnosis (EDX) in neuromuscular disorders. As in all invasive procedures there is a risk of bleeding complications, but which is rare according to the current literature. Controlled, prospective studies that include patients under anticoagulation or antiplatelet therapy are lacking and would be difficult to conduct. Case reports We describe two patients with no history of coagulopathy who developed an intramuscular hematoma after needle EMG. They had been under therapeutic anticoagulation but this had been discontinued, and their standard coagulation parameters had returned to normal prior to the EMG. One patient was found to have a rare genetic defect in thromboxane synthesis with associated markedly impaired platelet aggregation, while no obvious cause of the bleeding was found in the second patient. However, it could have been due to an unexpectedly strong anticoagulatory response to the oral anticoagulant apixaban. Conclusion One must be aware of the increased risk of bleeding events in patients with therapeutic anticoagulation. These can occur even when the recommendations regarding discontinuation of anticoagulant drugs for the procedure have been followed. The patient must be actively questioned for ongoing use of NSAIDs, and if pain therapy is required alternatives with no antiplatelet activity should be given. A larger data pool of adverse EMG events would aid in risk assessment and decision making.
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- 2021
5. Effects of Transcranial Electrical Stimulation on Sensory Functions
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Chaieb, Leila, primary, Saiote, Catarina, additional, Paulus, Walter, additional, and Antal, Andrea, additional
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- 2014
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6. Contributors
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Antal, Andrea, primary, Assaf, Souhile, additional, Bikson, Marom, additional, Boggio, Paulo, additional, Brunoni, Andre, additional, Chaieb, Leila, additional, Cohen, Leonardo G., additional, Cohen Kadosh, Roi, additional, Delgado-García, José María, additional, Elliott, Paul, additional, Fecteau, Shirley, additional, Ferrucci, Roberta, additional, Fink, Gereon R., additional, Fitz, Nicholas S., additional, Fregni, Felipe, additional, Fritsch, Brita, additional, Fumagalli, Manuela, additional, Gebodh, Nigel, additional, Gruart, Agnès, additional, Guleyupoglu, Berkan, additional, Hesse, Maike D., additional, Hone-Blanchet, Antoine, additional, Hummel, Friedhelm C., additional, Kerr, Joseph, additional, Krause, Beatrix, additional, Lavidor, Michal, additional, Leal-Campanario, Rocío, additional, Levy, Neil, additional, Looi, Chung Yen, additional, Mameli, Francesca, additional, Márquez-Ruiz, Javier, additional, Minhas, Preet, additional, Moreno-Duarte, Ingrid, additional, Nair, Abhilash, additional, Paulus, Walter, additional, Prichard, George, additional, Priori, Alberto, additional, Reato, Davide, additional, Reiner, Peter B., additional, Reis, Janine, additional, Ruffini, Giulio, additional, Saiote, Catarina, additional, Sandrini, Marco, additional, Savulescu, Julian, additional, Schestatsky, Pedro, additional, Sela, Tal, additional, Stagg, Charlotte J., additional, Truong, Dennis, additional, Wendling, Fabrice, additional, and Zimerman, Maximo, additional
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- 2014
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7. Transcranial electric and magnetic stimulation
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Paulus, Walter, primary, Peterchev, Angel V., additional, and Ridding, Michael, additional
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- 2013
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8. Contributors
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Allen, Richard P., primary, Balkam, Robert, additional, Beard, John, additional, Becker, Philip M., additional, Bell, Georgianna, additional, Benes, Heike, additional, Berger, Klaus, additional, Bliwise, Donald L., additional, Buchfuhrer, Mark J., additional, Chan, Allison, additional, Chokroverty, Sudhansu, additional, Clardy, Stacey L., additional, Connor, James R., additional, Earley, Christopher J., additional, Fahn, Stanley, additional, Ferini-Strambi, Luigi, additional, Ferri, Raffaele, additional, Freeman, Amanda A. H., additional, Garcia-Borreguero, Diego, additional, Gaspar, Claudia, additional, Gschliesser, Viola, additional, Guilleminault, Christian, additional, Gunzel, Jill, additional, Guthrie, Pickett, additional, Hening, Wayne A., additional, Högl, Birgit, additional, Kohnen, Ralf, additional, Kurth, Tobias, additional, Lanfranchi, Paola, additional, Laverdure-Dupont, Danièle, additional, Lavigne, Gilles, additional, Lee, Hochang Benjamin, additional, Levchenko, Anastasia, additional, Lugaresi, Elio, additional, Manconi, Mauro, additional, Michaud, Martin, additional, Montagna, Pasquale, additional, Montplaisir, Jacques, additional, Ondo, William, additional, Paulus, Walter, additional, Pennestri, Marie-Hélène, additional, Picchietti, Daniel L., additional, Poewe, Werner, additional, Polydefkis, Michael, additional, Provini, Federica, additional, Rouleau, Guy A., additional, Rye, David B., additional, Schomburg, Eike D., additional, Silber, Michael H., additional, Soja, Peter, additional, Trenkwalder, Claudia, additional, Turecki, Gustavo, additional, Ulfberg, Jan, additional, Vetrugno, Roberto, additional, Walters, Arthur S., additional, Winkelman, John W., additional, and Xiong, Lan, additional
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- 2009
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9. Spinal Cord, Dopamine, Opiates, and Restless Legs Syndrome
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Paulus, Walter, primary and Schomburg, Eike D, additional
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- 2009
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10. Chapter 25 Visual dysfunction in disorders with altered dopaminergic neurotransmission
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Antal, Andrea, primary, Bodis-Wollner, Ivan, additional, and Paulus, Walter, additional
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- 2005
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11. Chapter 75 Outlasting excitability shifts induced by direct current stimulation of the human brain
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Paulus, Walter, primary
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- 2004
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12. Chapter 41 Can epilepsies be improved by repetitive transcranial magnetic stimulation? - interim analysis of a controlled study
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Tergau, Frithjof, primary, Neumann, Daniela, additional, Rosenow, Felix, additional, Nitsche, Michael A., additional, Paulus, Walter, additional, and Steinhoff, Bernhard, additional
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- 2003
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13. Chapter 30 Transcranial magnetic and direct current stimulation of the visual cortex
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Antal, Andrea, primary, Nitsche, Michael A., additional, and Paulus, Walter, additional
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- 2003
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14. Chapter 4 Pulse configuration and rTMS efficacy: a review of clinical studies
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Sommer, Martin, primary and Paulus, Walter, additional
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- 2003
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15. Chapter 28 Modulation of motor consolidation by external DC stimulation
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Lang, Nicolas, primary, Nitsche, Michael A., additional, Sommer, Martin, additional, Tergau, Frithjof, additional, and Paulus, Walter, additional
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- 2003
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16. Preface
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Paulus, Walter, primary, Hallett, Mark, additional, Nitsche, Michael A., additional, Rothwell, John C., additional, Tergau, Frithjof, additional, and Ziemann, Ulf, additional
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- 2003
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17. Chapter 27 Modulation of cortical excitability by weak direct current stimulation – technical, safety and functional aspects
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Nitsche, Michael A., primary, Liebetanz, David, additional, Antal, Andrea, additional, Lang, Nicolas, additional, Tergau, Frithjof, additional, and Paulus, Walter, additional
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- 2003
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18. Identification of novel risk loci for restless legs syndrome in genome-wide association studies in individuals of European ancestry: a meta-analysis
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Schormair, Barbara, Zhao, Chen, Bell, Steven, Tilch, Erik, Salminen, Aaro V, Pütz, Benno, Dauvilliers, Yves, Stefani, Ambra, Högl, Birgit, Poewe, Werner, Kemlink, David, Sonka, Karel, Bachmann, Cornelius G, Paulus, Walter, Trenkwalder, Claudia, Oertel, Wolfgang H, Hornyak, Magdolna, Teder-Laving, Maris, Metspalu, Andres, Hadjigeorgiou, Georgios M, Polo, Olli, Fietze, Ingo, Ross, Owen A, Wszolek, Zbigniew, Butterworth, Adam S, Soranzo, Nicole, Ouwehand, Willem H, Roberts, David J, Danesh, John, Allen, Richard P, Earley, Christopher J, Ondo, William G, Xiong, Lan, Montplaisir, Jacques, Gan-Or, Ziv, Perola, Markus, Vodicka, Pavel, Dina, Christian, Franke, Andre, Tittmann, Lukas, Stewart, Alexandre FR, Shah, Svati H, Gieger, Christian, Peters, Annette, Rouleau, Guy A, Berger, Klaus, Oexle, Konrad, Di Angelantonio, Emanuele, Hinds, David A, Müller-Myhsok, Bertram, Winkelmann, Juliane, 23andMe Research Team, and DESIR Study Group
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DNA-Binding Proteins ,Restless Legs Syndrome ,European Continental Ancestry Group ,Humans ,Genetic Predisposition to Disease ,Nerve Tissue Proteins ,Semaphorins ,GPI-Linked Proteins ,3. Good health ,Genome-Wide Association Study ,Transcription Factors - Abstract
BACKGROUND: Restless legs syndrome is a prevalent chronic neurological disorder with potentially severe mental and physical health consequences. Clearer understanding of the underlying pathophysiology is needed to improve treatment options. We did a meta-analysis of genome-wide association studies (GWASs) to identify potential molecular targets. METHODS: In the discovery stage, we combined three GWAS datasets (EU-RLS GENE, INTERVAL, and 23andMe) with diagnosis data collected from 2003 to 2017, in face-to-face interviews or via questionnaires, and involving 15 126 cases and 95 725 controls of European ancestry. We identified common variants by fixed-effect inverse-variance meta-analysis. Significant genome-wide signals (p≤5 × 10(-8)) were tested for replication in an independent GWAS of 30 770 cases and 286 913 controls, followed by a joint analysis of the discovery and replication stages. We did gene annotation, pathway, and gene-set-enrichment analyses and studied the genetic correlations between restless legs syndrome and traits of interest. FINDINGS: We identified and replicated 13 new risk loci for restless legs syndrome and confirmed the previously identified six risk loci. MEIS1 was confirmed as the strongest genetic risk factor for restless legs syndrome (odds ratio 1·92, 95% CI 1·85-1·99). Gene prioritisation, enrichment, and genetic correlation analyses showed that identified pathways were related to neurodevelopment and highlighted genes linked to axon guidance (associated with SEMA6D), synapse formation (NTNG1), and neuronal specification (HOXB cluster family and MYT1). INTERPRETATION: Identification of new candidate genes and associated pathways will inform future functional research. Advances in understanding of the molecular mechanisms that underlie restless legs syndrome could lead to new treatment options. We focused on common variants; thus, additional studies are needed to dissect the roles of rare and structural variations. FUNDING: Deutsche Forschungsgemeinschaft, Helmholtz Zentrum München-Deutsches Forschungszentrum für Gesundheit und Umwelt, National Research Institutions, NHS Blood and Transplant, National Institute for Health Research, British Heart Foundation, European Commission, European Research Council, National Institutes of Health, National Institute of Neurological Disorders and Stroke, NIH Research Cambridge Biomedical Research Centre, and UK Medical Research Council.
19. Clinical neurophysiology in the treatment of movement disorders: IFCN handbook chapter.
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Lefaucheur JP, Moro E, Shirota Y, Ugawa Y, Grippe T, Chen R, Benninger DH, Jabbari B, Attaripour S, Hallett M, and Paulus W
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- Humans, Neurophysiology methods, Transcranial Magnetic Stimulation methods, Movement Disorders therapy, Movement Disorders physiopathology, Deep Brain Stimulation methods, Transcranial Direct Current Stimulation methods
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In this review, different aspects of the use of clinical neurophysiology techniques for the treatment of movement disorders are addressed. First of all, these techniques can be used to guide neuromodulation techniques or to perform therapeutic neuromodulation as such. Neuromodulation includes invasive techniques based on the surgical implantation of electrodes and a pulse generator, such as deep brain stimulation (DBS) or spinal cord stimulation (SCS) on the one hand, and non-invasive techniques aimed at modulating or even lesioning neural structures by transcranial application. Movement disorders are one of the main areas of indication for the various neuromodulation techniques. This review focuses on the following techniques: DBS, repetitive transcranial magnetic stimulation (rTMS), low-intensity transcranial electrical stimulation, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS), and focused ultrasound (FUS), including high-intensity magnetic resonance-guided FUS (MRgFUS), and pulsed mode low-intensity transcranial FUS stimulation (TUS). The main clinical conditions in which neuromodulation has proven its efficacy are Parkinson's disease, dystonia, and essential tremor, mainly using DBS or MRgFUS. There is also some evidence for Tourette syndrome (DBS), Huntington's disease (DBS), cerebellar ataxia (tDCS), and axial signs (SCS) and depression (rTMS) in PD. The development of non-invasive transcranial neuromodulation techniques is limited by the short-term clinical impact of these techniques, especially rTMS, in the context of very chronic diseases. However, at-home use (tDCS) or current advances in the design of closed-loop stimulation (tACS) may open new perspectives for the application of these techniques in patients, favored by their easier use and lower rate of adverse effects compared to invasive or lesioning methods. Finally, this review summarizes the evidence for keeping the use of electromyography to optimize the identification of muscles to be treated with botulinum toxin injection, which is indicated and widely performed for the treatment of various movement disorders., (Copyright © 2024 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
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- 2024
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20. European medical device regulation: Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away.
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Paulus W
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- Humans, Europe, Equipment and Supplies standards, Medical Device Legislation
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- 2024
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21. Paving the Road for Interleukin-6 Inhibition in Heart Failure With Preserved Ejection Fraction.
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Paulus WJ
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- Humans, Stroke Volume physiology, Interleukin-6, Ventricular Function, Left physiology, Hospitalization, Heart Failure drug therapy
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Competing Interests: Funding Support and Author Disclosures The author has reported that he has no relationships relevant to the contents of this paper to disclose.
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- 2023
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22. Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee.
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Vucic S, Stanley Chen KH, Kiernan MC, Hallett M, Benninger DH, Di Lazzaro V, Rossini PM, Benussi A, Berardelli A, Currà A, Krieg SM, Lefaucheur JP, Long Lo Y, Macdonell RA, Massimini M, Rosanova M, Picht T, Stinear CM, Paulus W, Ugawa Y, Ziemann U, and Chen R
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- Humans, Transcranial Magnetic Stimulation methods, Evoked Potentials, Motor physiology, Nervous System Diseases, Amyotrophic Lateral Sclerosis, Alzheimer Disease
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The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504-32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer's disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentato-thalamo-motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity., (Copyright © 2023 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
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- 2023
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23. Can individually targeted and optimized multi-channel tDCS outperform standard bipolar tDCS in stimulating the primary somatosensory cortex?
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Khan A, Antonakakis M, Suntrup-Krueger S, Lencer R, Nitsche MA, Paulus W, Groß J, and Wolters CH
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- Humans, Somatosensory Cortex physiology, Electroencephalography methods, Magnetoencephalography, Brain, Transcranial Direct Current Stimulation methods
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Background: Transcranial direct current stimulation (tDCS) has emerged as a non-invasive neuro-modulation technique. Most studies show that anodal tDCS increases cortical excitability, however, with variable outcomes. Previously, we have shown in computer simulations that our multi-channel tDCS (mc-tDCS) approach, the distributed constrained maximum intensity (D-CMI) method can potentially lead to better controlled tDCS results due to the improved directionality of the injected current at the target side for individually optimized D-CMI montages., Objective: In this study, we test the application of the D-CMI approach in an experimental study to stimulate the somatosensory P20/N20 target source in Brodmann area 3b and compare it with standard bipolar tDCS and sham conditions., Methods: We applied anodal D-CMI, the standard bipolar and D-CMI based Sham tDCS for 10 min to target the 20 ms post-stimulus somatosensory P20/N20 target brain source in Brodmann area 3b reconstructed using combined magnetoencephalography (MEG) and electroencephalography (EEG) source analysis in realistic head models with calibrated skull conductivity in a group-study with 13 subjects. Finger-stimulated somatosensory evoked fields (SEF) were recorded and the component at 20 ms post-stimulus (M20) was analyzed before and after the application of the three tDCS conditions in order to read out the stimulation effect on Brodmann area 3b., Results: Analysis of the finger stimulated SEF M20 peak before (baseline) and after tDCS shows a significant increase in source amplitude in Brodmann area 3b for D-CMI (6-16 min after tDCS), while no significant effects are found for standard bipolar (6-16 min after tDCS) and sham (6-16 min after tDCS) stimulation conditions. For the later time courses (16-26 and 27-37 min post-stimulation), we found a significant decrease in M20 peak source amplitude for standard bipolar and sham tDCS, while there was no effect for D-CMI., Conclusion: Our results indicate that targeted and optimized, and thereby highly individualized, mc-tDCS can outperform standard bipolar stimulation and lead to better control over stimulation outcomes with, however, a considerable amount of additional work compared to standard bipolar tDCS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2023
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24. Digitalized transcranial electrical stimulation: A consensus statement.
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Brunoni AR, Ekhtiari H, Antal A, Auvichayapat P, Baeken C, Benseñor IM, Bikson M, Boggio P, Borroni B, Brighina F, Brunelin J, Carvalho S, Caumo W, Ciechanski P, Charvet L, Clark VP, Cohen Kadosh R, Cotelli M, Datta A, Deng ZD, De Raedt R, De Ridder D, Fitzgerald PB, Floel A, Frohlich F, George MS, Ghobadi-Azbari P, Goerigk S, Hamilton RH, Jaberzadeh SJ, Hoy K, Kidgell DJ, Zonoozi AK, Kirton A, Laureys S, Lavidor M, Lee K, Leite J, Lisanby SH, Loo C, Martin DM, Miniussi C, Mondino M, Monte-Silva K, Morales-Quezada L, Nitsche MA, Okano AH, Oliveira CS, Onarheim B, Pacheco-Barrios K, Padberg F, Nakamura-Palacios EM, Palm U, Paulus W, Plewnia C, Priori A, Rajji TK, Razza LB, Rehn EM, Ruffini G, Schellhorn K, Zare-Bidoky M, Simis M, Skorupinski P, Suen P, Thibaut A, Valiengo LCL, Vanderhasselt MA, Vanneste S, Venkatasubramanian G, Violante IR, Wexler A, Woods AJ, and Fregni F
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- Consensus, Electric Stimulation, Humans, Telemedicine, Transcranial Direct Current Stimulation methods
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Objective: Although relatively costly and non-scalable, non-invasive neuromodulation interventions are treatment alternatives for neuropsychiatric disorders. The recent developments of highly-deployable transcranial electric stimulation (tES) systems, combined with mobile-Health technologies, could be incorporated in digital trials to overcome methodological barriers and increase equity of access. The study aims are to discuss the implementation of tES digital trials by performing a systematic scoping review and strategic process mapping, evaluate methodological aspects of tES digital trial designs, and provide Delphi-based recommendations for implementing digital trials using tES., Methods: We convened 61 highly-productive specialists and contacted 8 tES companies to assess 71 issues related to tES digitalization readiness, and processes, barriers, advantages, and opportunities for implementing tES digital trials. Delphi-based recommendations (>60% agreement) were provided., Results: The main strengths/opportunities of tES were: (i) non-pharmacological nature (92% of agreement), safety of these techniques (80%), affordability (88%), and potential scalability (78%). As for weaknesses/threats, we listed insufficient supervision (76%) and unclear regulatory status (69%). Many issues related to methodological biases did not reach consensus. Device appraisal showed moderate digitalization readiness, with high safety and potential for trial implementation, but low connectivity., Conclusions: Panelists recognized the potential of tES for scalability, generalizability, and leverage of digital trials processes; with no consensus about aspects regarding methodological biases., Significance: We further propose and discuss a conceptual framework for exploiting shared aspects between mobile-Health tES technologies with digital trials methodology to drive future efforts for digitizing tES trials., (Copyright © 2022 International Federation of Clinical Neurophysiology. All rights reserved.)
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- 2022
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25. Transcranial magnetic stimulation of the brain: What is stimulated? - A consensus and critical position paper.
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Siebner HR, Funke K, Aberra AS, Antal A, Bestmann S, Chen R, Classen J, Davare M, Di Lazzaro V, Fox PT, Hallett M, Karabanov AN, Kesselheim J, Beck MM, Koch G, Liebetanz D, Meunier S, Miniussi C, Paulus W, Peterchev AV, Popa T, Ridding MC, Thielscher A, Ziemann U, Rothwell JC, and Ugawa Y
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- Action Potentials, Consensus, Evoked Potentials, Motor physiology, Humans, Neurons physiology, Brain physiology, Transcranial Magnetic Stimulation
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Transcranial (electro)magnetic stimulation (TMS) is currently the method of choice to non-invasively induce neural activity in the human brain. A single transcranial stimulus induces a time-varying electric field in the brain that may evoke action potentials in cortical neurons. The spatial relationship between the locally induced electric field and the stimulated neurons determines axonal depolarization. The induced electric field is influenced by the conductive properties of the tissue compartments and is strongest in the superficial parts of the targeted cortical gyri and underlying white matter. TMS likely targets axons of both excitatory and inhibitory neurons. The propensity of individual axons to fire an action potential in response to TMS depends on their geometry, myelination and spatial relation to the imposed electric field and the physiological state of the neuron. The latter is determined by its transsynaptic dendritic and somatic inputs, intrinsic membrane potential and firing rate. Modeling work suggests that the primary target of TMS is axonal terminals in the crown top and lip regions of cortical gyri. The induced electric field may additionally excite bends of myelinated axons in the juxtacortical white matter below the gyral crown. Neuronal excitation spreads ortho- and antidromically along the stimulated axons and causes secondary excitation of connected neuronal populations within local intracortical microcircuits in the target area. Axonal and transsynaptic spread of excitation also occurs along cortico-cortical and cortico-subcortical connections, impacting on neuronal activity in the targeted network. Both local and remote neural excitation depend critically on the functional state of the stimulated target area and network. TMS also causes substantial direct co-stimulation of the peripheral nervous system. Peripheral co-excitation propagates centrally in auditory and somatosensory networks, but also produces brain responses in other networks subserving multisensory integration, orienting or arousal. The complexity of the response to TMS warrants cautious interpretation of its physiological and behavioural consequences, and a deeper understanding of the mechanistic underpinnings of TMS will be critical for advancing it as a scientific and therapeutic tool., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Andrea Antal has received honoraria from NeuroCare GmbH, Germany and Savir GmbH, Germany. Peter T. Fox has received patents in multiple jurisdictions for various TMS technologies, including the cortical column cosine model (C3) and the delivery of transcranial magnetic stimulation in accordance with the C3 model in an image-guided or robotically controlled manner. These patents are assigned to the University of Texas Board of Regents and have been licensed for commercialization by the University of Texas to a private entity in which Dr. Fox has ownership interest. Mark Hallett is an inventor of patents held by NIH for an immunotoxin for the treatment of focal movement disorders and the H-coil for magnetic stimulation; in relation to the latter, he has received license fee payments from the NIH (from Brainsway). He is on the Medical Advisory Boards of CALA Health and Brainsway (both unpaid positions). He is on the Editorial Board of approximately 15 journals and receives royalties and/or honoraria from publishing from Cambridge University Press, Oxford University Press, Springer, Wiley, Wolters Kluwer, and Elsevier. He has research grants from Medtronic, Inc. for a study of DBS for dystonia and CALA Health for studies of a device to suppress tremor. Hartwig R. Siebner has received honoraria as speaker from Sanofi Genzyme, Denmark and Novartis, Denmark, as consultant from Sanofi Genzyme, Denmark, Lophora, Denmark, and Lundbeck AS, Denmark, and as editor-in-chief (Neuroimage Clinical) and senior editor (NeuroImage) from Elsevier Publishers, Amsterdam, The Netherlands. He has received royalties as book editor from Springer Publishers, Stuttgart, Germany and from Gyldendal Publishers, Copenhagen, Denmark. Yoshikazu Ugawa has received honoraria from Takeda Pharmaceutical Company Limited, Eisai Co., Ltd., FP Pharmaceutical Corporation, Otsuka Pharmaceutical Co., Ltd., Elsevier Japan K. K., Kyowa Hakko Kirin Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Mitsubishi Tanabe Pharma Corporation, NIHON PHARMACEUTICAL Co., Ltd., and Novartis Pharma K.K. He has received royalties as journal editor from CHUGAI-IGAKUSHA, Igaku-Shoin Ltd, Medical View Co. Ltd., and Blackwell Publishing K.K. Walter Paulus has received honoraria as speaker from Philips, Medipark Clinic and as a consultant from Abott and Precisis AG. A.V. Peterchev has received research funding, travel support, patent royalties, consulting fees, equipment loans, hardware donations, and/or patent application support from Rogue Research, Tal Medical/Neurex, Magstim, MagVenture, Neuronetics, BTL Industries, and Advise Connect Inspire. Ulf Ziemann received grants from Janssen Pharmaceuticals NV and Takeda Pharmaceutical Company Ltd., and consulting fees from Bayer Vital GmbH, Pfizer GmbH and CorTec GmbH. All other authors have no conflict of interest to report., (Copyright © 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
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- 2022
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26. Stuttering severity relates to frontotemporal low-beta synchronization during pre-speech preparation.
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Korzeczek A, Neef NE, Steinmann I, Paulus W, and Sommer M
- Subjects
- Adult, Humans, Neurophysiology, Reading, Speech physiology, Stuttering diagnosis
- Abstract
Objective: The neurophysiological dynamics of the occurrence of a stuttering event are largely unknown. This sensor-level EEG study investigated whether already the intention to speak alters the formation of the speech production network in stuttering., Methods: We studied alpha (8-13 Hz), low beta (15-25 Hz) and high beta (25-30 Hz) power modulation in 19 adults with developmental stuttering (AWS) and 19 fluently speaking control participants during speech intention., Results: Both groups show that the anticipation of overt reading coincides with broadband low-frequency suppression in posterior sensors, a common sign of network formation for speech production. Prior to fluent speech, frontotemporal alpha and low-beta power were weaker in AWS with mild stuttering but stronger in AWS with severe stuttering. These correlations were not significant prior stuttered speech. Further, post hoc comparisons confirmed the difference between AWS with mild and severe stuttering in low beta power., Conclusions: AWS with more severe stuttering seem to show stronger maintenance of the current cognitive or sensorimotor state, as stuttering severity was associated with increased beta power. Increased beta power levels may influence subsequent speech preparation and execution processes., Significance: Upcoming breakdowns of the speech production network as evident in actual stuttering are related to beta power during the intention to speak., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
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- 2022
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27. The role of the TMS parameters for activation of the corticospinal pathway to the diaphragm.
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Chakalov I, Antal A, Eckardt SS, Paulus W, Saager L, Meissner K, Bähr M, Moerer O, and Stephani C
- Subjects
- Diaphragm, Electromyography, Evoked Potentials, Motor physiology, Humans, Pyramidal Tracts, Reproducibility of Results, Motor Cortex physiology, Transcranial Magnetic Stimulation
- Abstract
Objective: The influence of the TMS-parameters on the efficacy and reliability to induce diaphragmatic motor-evoked potentials (diMEPs) has not been studied so far. Therefore, the objective of the present research is to probe the role of TMS- waveform (monophasic- [Mo] vs. biphasic-pulses [Bi]) and current direction (posterior-anterior [Pa] vs. anterior-posterior [Ap]) in the activation of the diaphragm., Methods: Four different pulse-configurations (Mo-Ap, Mo-Pa, Bi-Ap, Bi-Pa) were applied by means of neuronavigated-TMS and surface MEP-recordings at relaxed end-expiration in 19 healthy subjects. The parameters resting motor threshold (RMT), diMEP-amplitude and -latency, as well as best stimulation site (motor hotspot) and central motor conduction time were studied. Diaphragm movements were simultaneously recorded via ultrasound. To control for possible signal contamination the MEPs of muscles neighboring the diaphragm were also obtained., Results: The motor hotspots of the diaphragm showed similar spatial distribution for the Mo-Ap, Mo-Pa, Bi-Ap and Bi-Pa. The biphasic-pulses yielded significantly lower RMTs and higher diMEP-amplitudes as the monophasic-pulses. Anterior to posterior oriented Bi- and Mo-pulses evoked significantly shorter diMEP-latencies than the posterior-anterior oriented ones., Conclusions: The present research demonstrates that biphasic- as compared to monophasic-pulses require significantly less charge and time for inducing diMEPs., Significance: The biphasic-TMS is best suited for the demanding stimulation of the diaphragm., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. IC was promoted by “German Research Foundation-Clinician Scientist” academic qualification program (DFG-CS) and received financial support to perform the experiments in parallel to his specialist training in the University Medical Center in Göttingen, project number: 413501650., (Copyright © 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
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- 2022
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28. Non-invasive brain stimulation and neuroenhancement.
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Antal A, Luber B, Brem AK, Bikson M, Brunoni AR, Cohen Kadosh R, Dubljević V, Fecteau S, Ferreri F, Flöel A, Hallett M, Hamilton RH, Herrmann CS, Lavidor M, Loo C, Lustenberger C, Machado S, Miniussi C, Moliadze V, Nitsche MA, Rossi S, Rossini PM, Santarnecchi E, Seeck M, Thut G, Turi Z, Ugawa Y, Venkatasubramanian G, Wenderoth N, Wexler A, Ziemann U, and Paulus W
- Abstract
Attempts to enhance human memory and learning ability have a long tradition in science. This topic has recently gained substantial attention because of the increasing percentage of older individuals worldwide and the predicted rise of age-associated cognitive decline in brain functions. Transcranial brain stimulation methods, such as transcranial magnetic (TMS) and transcranial electric (tES) stimulation, have been extensively used in an effort to improve cognitive functions in humans. Here we summarize the available data on low-intensity tES for this purpose, in comparison to repetitive TMS and some pharmacological agents, such as caffeine and nicotine. There is no single area in the brain stimulation field in which only positive outcomes have been reported. For self-directed tES devices, how to restrict variability with regard to efficacy is an essential aspect of device design and function. As with any technique, reproducible outcomes depend on the equipment and how well this is matched to the experience and skill of the operator. For self-administered non-invasive brain stimulation, this requires device designs that rigorously incorporate human operator factors. The wide parameter space of non-invasive brain stimulation, including dose (e.g., duration, intensity (current density), number of repetitions), inclusion/exclusion (e.g., subject's age), and homeostatic effects, administration of tasks before and during stimulation, and, most importantly, placebo or nocebo effects, have to be taken into account. The outcomes of stimulation are expected to depend on these parameters and should be strictly controlled. The consensus among experts is that low-intensity tES is safe as long as tested and accepted protocols (including, for example, dose, inclusion/exclusion) are followed and devices are used which follow established engineering risk-management procedures. Devices and protocols that allow stimulation outside these parameters cannot claim to be "safe" where they are applying stimulation beyond that examined in published studies that also investigated potential side effects. Brain stimulation devices marketed for consumer use are distinct from medical devices because they do not make medical claims and are therefore not necessarily subject to the same level of regulation as medical devices (i.e., by government agencies tasked with regulating medical devices). Manufacturers must follow ethical and best practices in marketing tES stimulators, including not misleading users by referencing effects from human trials using devices and protocols not similar to theirs., (© 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V.)
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- 2022
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29. Confounding effects of caffeine on neuroplasticity induced by transcranial alternating current stimulation and paired associative stimulation.
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Zulkifly MFM, Merkohitaj O, Brockmöller J, and Paulus W
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- Adult, Double-Blind Method, Female, Humans, Male, Transcranial Direct Current Stimulation, Young Adult, Caffeine pharmacology, Evoked Potentials, Motor drug effects, Motor Cortex drug effects, Neuronal Plasticity drug effects
- Abstract
Objective: We examined the effects of caffeine, time of day, and alertness fluctuation on plasticity effects after transcranial alternating current stimulation (tACS) or 25 ms paired associative stimulation (PAS25) in caffeine-naïve and caffeine-adapted subjects., Methods: In two randomised, double-blinded, cross-over or placebo-controlled (caffeine) studies, we measured sixty subjects in eight sessions (n = 30, Male: Female = 1:1 in each study)., Results: We found caffeine increased motor cortex excitability in caffeine naïve subjects. The aftereffects in caffeine naïve subjects were enhanced and prolonged when combined with PAS 25. Caffeine also increased alertness and the motor evoked potentials (MEPs) were reduced under light deprivation in caffeine consumers both with and without caffeine. In caffeine consumers, the time of day had no effect on tACS-induced plasticity., Conclusions: We conclude that caffeine should be avoided or controlled as confounding factor for brain stimulation protocols. It is also important to keep the brightness constant in all sessions and study groups should not be mixed with caffeine-naïve and caffeine consuming participants., Significance: Caffeine is one of the confounding factors in the plasticity induction studies and it induces different excitability effects in caffeine-naïve and caffeine-adapted subjects. This study was registered in the ClinicalTrials.gov with these registration IDs: 1) NCT03720665 https://clinicaltrials.gov/ct2/results?cond=NCT03720665&term=&cntry=&state=&city=&dist= 2) NCT04011670 https://clinicaltrials.gov/ct2/results?cond=&term=NCT04011670&cntry=&state=&city=&dist=., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
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- 2021
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30. Training in the practice of noninvasive brain stimulation: Recommendations from an IFCN committee.
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Fried PJ, Santarnecchi E, Antal A, Bartres-Faz D, Bestmann S, Carpenter LL, Celnik P, Edwards D, Farzan F, Fecteau S, George MS, He B, Kim YH, Leocani L, Lisanby SH, Loo C, Luber B, Nitsche MA, Paulus W, Rossi S, Rossini PM, Rothwell J, Sack AT, Thut G, Ugawa Y, Ziemann U, Hallett M, and Pascual-Leone A
- Subjects
- Humans, Stereotaxic Techniques education, Stereotaxic Techniques standards, Transcranial Direct Current Stimulation standards, Transcranial Magnetic Stimulation standards, Brain physiology, Clinical Competence standards, Practice Guidelines as Topic standards, Transcranial Direct Current Stimulation methods, Transcranial Magnetic Stimulation methods
- Abstract
As the field of noninvasive brain stimulation (NIBS) expands, there is a growing need for comprehensive guidelines on training practitioners in the safe and effective administration of NIBS techniques in their various research and clinical applications. This article provides recommendations on the structure and content of this training. Three different types of practitioners are considered (Technicians, Clinicians, and Scientists), to attempt to cover the range of education and responsibilities of practitioners in NIBS from the laboratory to the clinic. Basic or core competencies and more advanced knowledge and skills are discussed, and recommendations offered regarding didactic and practical curricular components. We encourage individual licensing and governing bodies to implement these guidelines., Competing Interests: Declaration of Competing Interest The content of this manuscript is solely theresponsibility of the authors and does not necessarily represent the official views of any of the institutions involved or any of the funding agencies and bodies. Peter J. Fried has nothing to disclose with regard to this manuscript. Emiliano Santarnecchi serves on the scientific advisory boards for Neuroelectrics, EBNeuro and Neurocare. He is listed as an inventor on several issued and pending patents on the application of noninvasive brain stimulation in patients with dementia and brain tumors. Andrea Antal serves as a paid consultant for NeuroConn, Ilmenau, Germany and Savir GmbH, Magdeburg, Germany. She is supported by the State of Lower Saxony, Germany (76251-12-7/19 (ZN 3456)). David Bartres-Faz has nothing to disclose with regard to this manuscript. Sven Bestmann has nothing to disclose with regard to this manuscript. Linda L. Carpenter is supportedby the National Institute of General Medical Sciencesof the National Institutes of Health under Award Number P20GM130452 (Core Resources of the Butler Hospital COBRE Center for Neuromodulation). She has received consulting income from Neuronetics, Nexstim, Janssen, AffectNeuro, and Sage Therapeutics. She has research support from Neuronetics, Neosync, AffectNeuro, and Nexstim. Pablo Celnik has nothing to disclose with regard to this manuscript. Dylan Edwards has nothing to disclose with regard to this manuscript. Faranak Farzan has nothing to disclose with regard to this manuscript. Shirley Fecteau is a deputy editor of Brain Stimulation and an editor of Scientific Reports.She is regular faculty of yearly intensive mini-fellowships on TMS and tCS offered through Harvard Continuing Medical Education. Mark S. George is an unpaid consultant to Brainsway, Neuronetics, and Magstim. He has received loaned equipment or research grants from Mecta, Brainsway, Magstim, Magventure. He is a paid consultant to Neuralief. He does not own equity in any device company. He is the editor in chief of Brain Stimulation, with a stipend from Elsevier. Bin He has nothing to disclose with regard to this manuscript. Yun-Hee Kim has nothing to disclose with regard to this manuscript. Letizia Leocani is currently shortlisted for the European Commission expert panel on Medical Devices and in vitro diagnostic medical devices for Neurology. Sarah H. Lisanby is inventor on a patent for TMS technology, unrelated to the topic presented here, with no royalties.The opinions expressed in this article are the authors’ own and do not reflect the views of the National Institutes of Health, the Department of Health and Human Services, or the United States government. Colleen Loo has received competitive grant funding from the Australian National Health and Medical Research Council for brain stimulation research. Bruce Luber has nothing to disclose with regard to this manuscript. Michael A. Nitsche serves on the scientific advisory boards for Neuroelectrics and NeuroDevice. Walter Paulus serves as a member of the scientific advisory board of Precisis AG. Simone Rossi serves as a consultant for EB-Neuro and Neurocare Italy group. Paolo M. Rossini has nothing to disclose with regard to this manuscript. John Rothwell has nothing to disclose with regard to this manuscript. Alexander T. Sack serves as head of the scientific advisory board for AlphaSys Brain Technologies BV. He is founder of Neurowear Medical BV, and Director of the European Clinical TMS Certification Course (www.tmscourse.eu). Gregor Thut serves as a Section Editor for European Journal of Neuroscience and Brain Topography and as an Associate Editor for several Frontiers journals (Brain Imaging and Stimulation, Consciousness Research, Perception Science). Yoshikazu Ugawa has nothing to disclose with regard to this manuscript. Ulf Ziemann has received grants from European Research Council (ERC), German Research Foundation (DFG), German Federal Ministry of Education and Research (BMBF), Ministry of Research and Arts of the Federal State of Baden-Würrtemberg (MWK), Bristol Myers Squibb, Janssen Pharmaceutica NV, Servier, Biogen Idec GmbH, and personal fees from Bayer Vital GmbH, Pfizer GmbH, CorTec GmbH, all not related to this work. Mark Hallett was supported by the NINDS Intramural Program. He is an inventor of patents held by NIH for an immunotoxin for the treatment of focal movement disorders and the H-coil for magnetic stimulation; in relation to the latter, he has received license fee payments from the NIH (from Brainsway). He is on the Medical Advisory Boards of CALA Health and Brainsway. He has research grants from Allergan for studies of methods to inject botulinum toxins, Medtronic, Inc. for a study of DBS for dystonia, and CALA Health for studies of a device to suppress tremor. Alvaro Pascual-Leone serves on the scientific advisory boards for Starlab Neuroscience, Neuroelectrics, Magstim, Magventure, MedRhythms, and Cognito. He listed as an inventor on several issued and pending patents on the real-time integration of transcranial magnetic stimulation with electroencephalography and magnetic resonance imaging, and novel methods for transcranial electric stimulation. He is co-founder of Linus Health and TI Solutions A.G. He serves as associate editor for Annals of Neurology. He is co-director of yearly intensive mini-fellowships on TMS and tCS offered through Harvard Continuing Medical Education., (Copyright © 2020. Published by Elsevier B.V.)
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- 2021
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31. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines.
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Rossi S, Antal A, Bestmann S, Bikson M, Brewer C, Brockmöller J, Carpenter LL, Cincotta M, Chen R, Daskalakis JD, Di Lazzaro V, Fox MD, George MS, Gilbert D, Kimiskidis VK, Koch G, Ilmoniemi RJ, Lefaucheur JP, Leocani L, Lisanby SH, Miniussi C, Padberg F, Pascual-Leone A, Paulus W, Peterchev AV, Quartarone A, Rotenberg A, Rothwell J, Rossini PM, Santarnecchi E, Shafi MM, Siebner HR, Ugawa Y, Wassermann EM, Zangen A, Ziemann U, and Hallett M
- Subjects
- Healthy Volunteers, Humans, Brain physiology, Transcranial Magnetic Stimulation adverse effects
- Abstract
This article is based on a consensus conference, promoted and supported by the International Federation of Clinical Neurophysiology (IFCN), which took place in Siena (Italy) in October 2018. The meeting intended to update the ten-year-old safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings (Rossi et al., 2009). Therefore, only emerging and new issues are covered in detail, leaving still valid the 2009 recommendations regarding the description of conventional or patterned TMS protocols, the screening of subjects/patients, the need of neurophysiological monitoring for new protocols, the utilization of reference thresholds of stimulation, the managing of seizures and the list of minor side effects. New issues discussed in detail from the meeting up to April 2020 are safety issues of recently developed stimulation devices and pulse configurations; duties and responsibility of device makers; novel scenarios of TMS applications such as in the neuroimaging context or imaging-guided and robot-guided TMS; TMS interleaved with transcranial electrical stimulation; safety during paired associative stimulation interventions; and risks of using TMS to induce therapeutic seizures (magnetic seizure therapy). An update on the possible induction of seizures, theoretically the most serious risk of TMS, is provided. It has become apparent that such a risk is low, even in patients taking drugs acting on the central nervous system, at least with the use of traditional stimulation parameters and focal coils for which large data sets are available. Finally, new operational guidelines are provided for safety in planning future trials based on traditional and patterned TMS protocols, as well as a summary of the minimal training requirements for operators, and a note on ethics of neuroenhancement., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
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- 2021
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32. A proposal for new diagnostic criteria for ALS.
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Shefner JM, Al-Chalabi A, Baker MR, Cui LY, de Carvalho M, Eisen A, Grosskreutz J, Hardiman O, Henderson R, Matamala JM, Mitsumoto H, Paulus W, Simon N, Swash M, Talbot K, Turner MR, Ugawa Y, van den Berg LH, Verdugo R, Vucic S, Kaji R, Burke D, and Kiernan MC
- Subjects
- Electromyography standards, Humans, Motor Neurons physiology, Muscle, Skeletal physiopathology, Reference Standards, Amyotrophic Lateral Sclerosis diagnosis, Electromyography methods
- Abstract
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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- 2020
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33. Possible role of backpropagating action potentials in corticospinal neurons in I-wave periodicity following a TMS pulse.
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Ugawa Y, Rothwell JC, and Paulus W
- Subjects
- Action Potentials, Neurons, Periodicity, Dendrites, Pyramidal Cells
- Abstract
A single pulse of TMS or direct electric stimulation over M1 causes repetitive synchronized firing of corticospinal tract (CST) neurons. Two mechanisms for the repetitive firing have been proposed: a cascade of synaptic inputs to the pyramidal neurons and a single reverberating circuit of interneurons. Here, we propose another possibility in which bursting of CST neurons is produced by dendritic Ca
2+ -spikes. Backpropagation of the initial action potential (I1-wave) from the soma interacts with synaptic input in the dendrites to initiate a dendritic calcium spike. These Ca2+ -spikes produce a burst of somatic action potentials that starts about 1.5 ms after the initial discharge of the neuron, which may produce the later I-waves., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)- Published
- 2020
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34. Corrigendum to "Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018)" [Clin. Neurophysiol. 131 (2020) 474-528].
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Lefaucheur JP, Aleman A, Baeken C, Benninger DH, Brunelin J, Di Lazzaro V, Filipović SR, Grefkes C, Hasan A, Hummel FC, Jääskeläinen SK, Langguth B, Leocani L, Londero A, Nardone R, Nguyen JP, Nyffeler T, Oliveira-Maia AJ, Oliviero A, Padberg F, Palm U, Paulus W, Poulet E, Quartarone A, Rachid F, Rektorová I, Rossi S, Sahlsten H, Schecklmann M, Szekely D, and Ziemann U
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- 2020
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35. Model-driven neuromodulation of the right posterior region promotes encoding of long-term memories.
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Alekseichuk I, Turi Z, Veit S, and Paulus W
- Subjects
- Adult, Brain Mapping, Female, Humans, Magnetic Resonance Imaging, Male, Memory, Long-Term, Models, Neurological, Parietal Lobe physiology, Transcranial Direct Current Stimulation methods
- Abstract
Background: Long-term recognition memory depends both on initial encoding and on subsequent recognition processes., Objective: In this study we aimed at improving long-term memory by modulating posterior parietal brain activity during the encoding process. If this area is causally involved in memory encoding, its facilitation should lead to behavioral improvement. Based on the dual-process memory framework, we also expected that the neuromodulation would dissociate subsequent familiarity-based and recollection-based recognition., Methods: We investigated the role of the posterior parietal brain oscillations in facial memory formation in three separate experiments using electroencephalography (EEG), functional magnetic resonance imaging (fMRI), and model-driven, multi-electrode transcranial alternating current stimulation (tACS)., Results: Using fMRI and EEG, we confirmed that the right posterior parietal cortex is an essential node that promotes the encoding of long-term memories. We found that single-trial low theta power in this region predicts subsequent long-term recognition. On this basis, we fine-tuned the spatial and frequency settings of tACS during memory encoding. Model-driven tACS over the right posterior brain area augmented subsequent long-term recognition memory and particularly the familiarity of the observed stimuli. The recollection process, and short-term task performance as control remained unchanged. Control stimulation over the left hemisphere had no behavioral effect., Conclusion: We conclude that the right posterior brain area is crucial in long-term memory encoding., (Copyright © 2019 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2020
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36. Transcranial alternating current stimulation induced excitatory aftereffects are abolished by decaffeinated espresso and reversed into inhibition by espresso with caffeine.
- Author
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Zulkifly MFM, Merkohitaj O, and Paulus W
- Subjects
- Adult, Evoked Potentials, Motor physiology, Female, Humans, Male, Motor Cortex physiology, Young Adult, Caffeine pharmacology, Coffee, Evoked Potentials, Motor drug effects, Motor Cortex drug effects, Transcranial Direct Current Stimulation
- Abstract
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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- 2020
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37. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018).
- Author
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Lefaucheur JP, Aleman A, Baeken C, Benninger DH, Brunelin J, Di Lazzaro V, Filipović SR, Grefkes C, Hasan A, Hummel FC, Jääskeläinen SK, Langguth B, Leocani L, Londero A, Nardone R, Nguyen JP, Nyffeler T, Oliveira-Maia AJ, Oliviero A, Padberg F, Palm U, Paulus W, Poulet E, Quartarone A, Rachid F, Rektorová I, Rossi S, Sahlsten H, Schecklmann M, Szekely D, and Ziemann U
- Subjects
- Evidence-Based Medicine standards, Humans, Transcranial Magnetic Stimulation adverse effects, Transcranial Magnetic Stimulation standards, Mental Disorders therapy, Nervous System Diseases therapy, Practice Guidelines as Topic, Transcranial Magnetic Stimulation methods
- Abstract
A group of European experts reappraised the guidelines on the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) previously published in 2014 [Lefaucheur et al., Clin Neurophysiol 2014;125:2150-206]. These updated recommendations take into account all rTMS publications, including data prior to 2014, as well as currently reviewed literature until the end of 2018. Level A evidence (definite efficacy) was reached for: high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the painful side for neuropathic pain; HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) using a figure-of-8 or a H1-coil for depression; low-frequency (LF) rTMS of contralesional M1 for hand motor recovery in the post-acute stage of stroke. Level B evidence (probable efficacy) was reached for: HF-rTMS of the left M1 or DLPFC for improving quality of life or pain, respectively, in fibromyalgia; HF-rTMS of bilateral M1 regions or the left DLPFC for improving motor impairment or depression, respectively, in Parkinson's disease; HF-rTMS of ipsilesional M1 for promoting motor recovery at the post-acute stage of stroke; intermittent theta burst stimulation targeted to the leg motor cortex for lower limb spasticity in multiple sclerosis; HF-rTMS of the right DLPFC in posttraumatic stress disorder; LF-rTMS of the right inferior frontal gyrus in chronic post-stroke non-fluent aphasia; LF-rTMS of the right DLPFC in depression; and bihemispheric stimulation of the DLPFC combining right-sided LF-rTMS (or continuous theta burst stimulation) and left-sided HF-rTMS (or intermittent theta burst stimulation) in depression. Level A/B evidence is not reached concerning efficacy of rTMS in any other condition. The current recommendations are based on the differences reached in therapeutic efficacy of real vs. sham rTMS protocols, replicated in a sufficient number of independent studies. This does not mean that the benefit produced by rTMS inevitably reaches a level of clinical relevance., (Copyright © 2019 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
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- 2020
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38. Effects of electrode angle-orientation on the impact of transcranial direct current stimulation on motor cortex excitability.
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Foerster Á, Yavari F, Farnad L, Jamil A, Paulus W, Nitsche MA, and Kuo MF
- Subjects
- Adult, Electrodes, Female, Humans, Male, Evoked Potentials, Motor, Motor Cortex physiology, Neuronal Plasticity, Transcranial Direct Current Stimulation methods
- Abstract
Background: For effects of transcranial direct current stimulation (tDCS), electrical field distribution and coverage of the target areas play a decisive role., Methods: We explored the effect of different angle-orientations of tDCS electrodes applied over the upper limb motor cortex (M1) on motor cortex excitability in healthy volunteers. Sixteen individuals received 1 mA anodal or cathodal tDCS through 35 cm
2 electrodes over M1 for 15 min. Transcranial magnetic stimulation was used to examine tDCS-generated cortical excitability effects. The M1 electrode-orientation was following the right-left longitudinal plane, or positioned with 45° deviation from the midsagittal plane. Coverage of underlying brain and electrical field orientation were also investigated., Results: Cortical excitability modulation was observed only when the electrode was aligned with 45° angle, which covered a larger area of the motor cortex., Conclusion: an electrode angle-orientation of 45° induces superior neuroplastic effects of M1 due to a better alignment with the motor cortex., (Copyright © 2018 Elsevier Inc. All rights reserved.)- Published
- 2019
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39. TMS of primary motor cortex with a biphasic pulse activates two independent sets of excitable neurones.
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Sommer M, Ciocca M, Chieffo R, Hammond P, Neef A, Paulus W, Rothwell JC, and Hannah R
- Subjects
- Adult, Differential Threshold, Female, Humans, Male, Transcranial Magnetic Stimulation instrumentation, Young Adult, Evoked Potentials, Motor physiology, Interneurons physiology, Motor Cortex physiology, Transcranial Magnetic Stimulation methods
- Abstract
Background: Biphasic pulses produced by most commercially available TMS machines have a cosine waveform, which makes it difficult to study the interaction between the two phases of stimulation., Objective: We used a controllable pulse TMS (cTMS) device delivering quasi-rectangular pulse outputs to investigate whether monophasic are more effective than biphasic pulses., Methods: Temporally symmetric ("biphasic") or highly asymmetric ("monophasic") charge-balanced biphasic stimuli were used to target the hand area of motor cortex in the anterior-posterior (AP) or posterior-anterior (PA) initial current direction., Results: We observed the lowest motor thresholds and shortest motor evoked potential (MEP) latencies with initial PA pulses, and highest thresholds and longest latencies with AP pulses. Increasing pulse symmetry tended to increase threshold with a PA direction whereas it lowered thresholds and shortened latencies with an AP direction. Furthermore, it steepened the MEP input-output curve with both directions., Conclusions: "Biphasic" TMS pulses can be viewed as two monophasic pulses of opposite directions, each stimulating a different set of interneurons with different thresholds (PA < AP). At threshold, the reverse phase of an initially PA pulse increases threshold compared with "monophasic" stimulation. At higher intensities, the reverse phase begins to activate AP-sensitive neurones and increase the effectiveness of stimulation above that of a "monophasic" PA pulse. "Biphasic" stimulation with initially AP pulses is dominated at threshold by activation produced by the lower threshold reverse (PA) phase., Significance: The effects of biphasic stimulation are best understood as the summed output of two independent sets of directionally selective neural populations., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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40. Perturbation of theta-gamma coupling at the temporal lobe hinders verbal declarative memory.
- Author
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Lara GA, Alekseichuk I, Turi Z, Lehr A, Antal A, and Paulus W
- Subjects
- Adolescent, Adult, Double-Blind Method, Female, Humans, Male, Transcranial Direct Current Stimulation, Young Adult, Gamma Rhythm physiology, Memory, Long-Term physiology, Temporal Lobe physiology, Theta Rhythm physiology
- Abstract
Background: Phase-amplitude cross-frequency coupling (PAC) is characterized by the modulation of the power of a fast brain oscillation (e.g., gamma) by the phase of a slow rhythm (e.g., theta). PAC in different sub- and neocortical regions is known to underlie effective neural communication and correlates with successful long-term memory formation., Objective/hypothesis: The present work aims to extend earlier observational data, by probing the functional role of theta-gamma PAC in the left temporal cortex in humans during verbal long-term memory encoding., Methods: In three double-blinded, placebo-controlled experiments (n = 72), we employed cross-frequency transcranial alternating current stimulation (tACS) to externally modulate ongoing PAC during a verbal-associative learning task. Three types of cross-frequency tACS protocols were used: bursts of high gamma tACS were coupled to the peak or trough of the theta tACS cycle, and a control condition where gamma tACS was continuously superimposed at theta tACS cycles., Results: Gamma bursts coupled to the trough of theta tACS induced robust behavioral impairment in memory performance (p < .01), whereas gamma burst coupled to the peak or continuously superimposed with theta tACS had no significant behavioral effects., Conclusions: Our results demonstrate direct evidence regarding the importance of theta-gamma coupling in verbal long-term memory formation., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2018
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41. Diastole Tracks Cardiometabolic Risk.
- Author
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Paulus WJ and Dal Canto E
- Subjects
- Comorbidity, Diastole, Humans, Risk Factors, Heart Failure
- Published
- 2018
- Full Text
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42. Altered morphology of the nucleus accumbens in persistent developmental stuttering.
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Neef NE, Bütfering C, Auer T, Metzger FL, Euler HA, Frahm J, Paulus W, and Sommer M
- Subjects
- Adult, Basal Ganglia diagnostic imaging, Case-Control Studies, Cerebellum diagnostic imaging, Female, Humans, Male, Sex Factors, Magnetic Resonance Imaging methods, Nucleus Accumbens diagnostic imaging, Stuttering diagnostic imaging
- Abstract
Purpose: Neuroimaging studies in persistent developmental stuttering repeatedly report altered basal ganglia functions. Together with thalamus and cerebellum, these structures mediate sensorimotor functions and thus represent a plausible link between stuttering and neuroanatomy. However, stuttering is a complex, multifactorial disorder. Besides sensorimotor functions, emotional and social-motivational factors constitute major aspects of the disorder. Here, we investigated cortical and subcortical gray matter regions to study whether persistent developmental stuttering is also linked to alterations of limbic structures., Methods: The study included 33 right-handed participants who stutter and 34 right-handed control participants matched for sex, age, and education. Structural images were acquired using magnetic resonance imaging to estimate volumetric characteristics of the nucleus accumbens, hippocampus, amygdala, pallidum, putamen, caudate nucleus, and thalamus., Results: Volumetric comparisons and vertex-based shape comparisons revealed structural differences. The right nucleus accumbens was larger in participants who stutter compared to controls., Conclusion: Recent theories of basal ganglia functions suggest that the nucleus accumbens is a motivation-to-movement interface. A speaker intends to reach communicative goals, but stuttering can derail these efforts. It is therefore highly plausible to find alterations in the motivation-to-movement interface in stuttering. While behavioral studies of stuttering sought to find links between the limbic and sensorimotor system, we provide the first neuroimaging evidence of alterations in the limbic system. Thus, our findings might initialize a unified neurobiological framework of persistent developmental stuttering that integrates sensorimotor and social-motivational neuroanatomical circuitries., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2018
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43. Reply: Diabetes and Heart Failure: Are We in the Right Direction to Find the Right Morsel for Success?
- Author
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Paulus WJ and Dal Canto E
- Subjects
- Humans, Ventricular Function, Vildagliptin, Diabetes Mellitus, Type 2, Heart Failure
- Published
- 2018
- Full Text
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44. Distinct Myocardial Targets for Diabetes Therapy in Heart Failure With Preserved or Reduced Ejection Fraction.
- Author
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Paulus WJ and Dal Canto E
- Subjects
- Comorbidity, Diabetes Mellitus therapy, Heart Failure diagnosis, Heart Failure physiopathology, Humans, Diabetes Mellitus epidemiology, Diet, Carbohydrate-Restricted methods, Heart Failure epidemiology, Hypoglycemic Agents therapeutic use, Myocardium pathology, Stroke Volume physiology
- Abstract
Noncardiac comorbidities such as diabetes mellitus (DM) have different outcomes in heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF). These different outcomes are the result of distinct myocardial effects of DM on HFpEF and HFrEF, which relate to different mechanisms driving myocardial remodeling in each heart failure phenotype. Myocardial remodeling is driven by microvascular endothelial inflammation in HFpEF and by cardiomyocyte cell death in HFrEF. Evidence consists of: different biomarker profiles, in which inflammatory markers are prominent in HFpEF and markers of myocardial injury or wall stress are prominent in HFrEF; reduced coronary flow reserve with microvascular rarefaction in HFpEF; and upregulation of free radical-producing enzymes in endothelial cells in HFpEF and in cardiomyocytes in HFrEF. As biopsies from patients with diabetic cardiomyopathy reveal, DM affects failing myocardium by phenotype-specific mechanisms. In HFpEF, DM mainly increases cardiomyocyte hypertrophy and stiffness, probably because of hyperinsulinemia and microvascular endothelial inflammation. In HFrEF, DM augments replacement fibrosis because of cardiomyocyte cell death induced by lipotoxicity or advanced glycation end products. Because DM exerts distinct effects on myocardial remodeling in HFpEF and HFrEF, the heart failure phenotype is important for DM therapy., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
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45. The associative brain at work: Evidence from paired associative stimulation studies in humans.
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Suppa A, Quartarone A, Siebner H, Chen R, Di Lazzaro V, Del Giudice P, Paulus W, Rothwell JC, Ziemann U, and Classen J
- Subjects
- Humans, Association, Brain physiology, Electric Stimulation methods, Neuronal Plasticity physiology
- Abstract
The original protocol of Paired Associative Stimulation (PAS) in humans implies repetitive cortical and peripheral nerve stimuli, delivered at specific inter-stimulus intervals, able to elicit non-invasively long-term potentiation (LTP)- and long-term depression (LTD)-like plasticity in the human motor cortex. PAS has been designed to drive cortical LTP/LTD according to the Hebbian rule of associative plasticity. Over the last two decades, a growing number of researchers have increasingly used the PAS technique to assess cortical associative plasticity in healthy humans and in patients with movement disorders and other neuropsychiatric diseases. The present review covers the physiology, pharmacology, pathology and motor effects of PAS. Further sections of the review focus on new protocols of "modified PAS" and possible future application of PAS in neuromorphic circuits designed for brain-computer interface., (Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
- Published
- 2017
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46. Plasticity induced by non-invasive transcranial brain stimulation: A position paper.
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Huang YZ, Lu MK, Antal A, Classen J, Nitsche M, Ziemann U, Ridding M, Hamada M, Ugawa Y, Jaberzadeh S, Suppa A, Paulus W, and Rothwell J
- Subjects
- Humans, Brain physiology, Neuronal Plasticity physiology, Transcranial Direct Current Stimulation, Transcranial Magnetic Stimulation
- Abstract
Several techniques and protocols of non-invasive transcranial brain stimulation (NIBS), including transcranial magnetic and electrical stimuli, have been developed in the past decades. Non-invasive transcranial brain stimulation may modulate cortical excitability outlasting the period of non-invasive transcranial brain stimulation itself from several minutes to more than one hour. Quite a few lines of evidence, including pharmacological, physiological and behavioral studies in humans and animals, suggest that the effects of non-invasive transcranial brain stimulation are produced through effects on synaptic plasticity. However, there is still a need for more direct and conclusive evidence. The fragility and variability of the effects are the major challenges that non-invasive transcranial brain stimulation currently faces. A variety of factors, including biological variation, measurement reproducibility and the neuronal state of the stimulated area, which can be affected by factors such as past and present physical activity, may influence the response to non-invasive transcranial brain stimulation. Work is ongoing to test whether the reliability and consistency of non-invasive transcranial brain stimulation can be improved by controlling or monitoring neuronal state and by optimizing the protocol and timing of stimulation., (Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
- Published
- 2017
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47. Effect of early-onset preeclampsia on cardiovascular risk in the fifth decade of life.
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Bokslag A, Teunissen PW, Franssen C, van Kesteren F, Kamp O, Ganzevoort W, Paulus WJ, and de Groot CJM
- Subjects
- Adult, Albuminuria epidemiology, Body Mass Index, Case-Control Studies, Female, Follow-Up Studies, Glycated Hemoglobin analysis, Humans, Hypertension epidemiology, Lipids blood, Metabolic Syndrome epidemiology, Middle Aged, Netherlands epidemiology, Pregnancy, Prospective Studies, Risk Assessment, Risk Factors, Women's Health, Cardiovascular Diseases epidemiology, Pre-Eclampsia epidemiology
- Abstract
Background: Women with hypertensive disorders in pregnancy, in particular early-onset preeclampsia, are at increased risk of developing cardiovascular disease later in life. These women have a more than 2-fold increased risk of dying from cardiovascular diseases. Most studies have focused on identification of risk factors shortly after pregnancy. Less is known on the prevalence of risk factors or actual signs of cardiovascular disease 5-20 years later. The presence of hypertension or metabolic syndrome can be seen as an opportunity for preventive interventions to reduce the development of severe cardiovascular diseases like myocardial infarction and stroke., Objective: To assess cardiovascular risk factors and established cardiovascular disease in women after early-onset preeclampsia, in the fifth decade of life. As a consequence, we can assess whether there is still a window of opportunity for preventive measures and to establish in what proportion of women cardiovascular disease already has developed., Study Design: In a prospective observational study, cardiovascular risk assessment was performed in women with early-onset preeclampsia (<34 weeks' gestation) and normotensive controls (≥37 weeks' gestation) 9-16 years after their index pregnancy. Medical records of 2 tertiary hospitals in Amsterdam, The Netherlands, were screened consecutively, and all eligible women were invited. Cardiovascular risk assessment consisted of a questionnaire, blood pressure measurement, anthropometrics, and blood and urine for fasting lipids, lipoproteins, glucose levels, glycated hemoglobin, renal function, N-terminal brain natriuretic peptide, and albuminuria. History of cardiovascular diseases (ie, myocardial infarction and stroke) was determined. Prevalence of women presenting in an optimal window of opportunity for preventive measures was defined by the presence of cardiovascular risk factors (ie, hypertension and metabolic syndrome) but in the absence of established cardiovascular diseases (ie, myocardial infarction and stroke)., Results: Women with a history of early-onset preeclampsia (n = 131) had significantly greater systolic and diastolic blood pressure, greater body mass index, more often had an abnormal lipid profile (lower high-density lipoprotein levels, higher triglycerides), greater glycated hemoglobin, and greater levels of albuminuria compared to controls (n = 56). None of the women with a history of early-onset preeclampsia was diagnosed with cardiovascular disease; 38.2% were diagnosed with hypertension; and 18.2% were diagnosed with metabolic syndrome. A total of 42% met the criteria for the window of opportunity for preventive measures. In women with a history of an uncomplicated pregnancy, no women were diagnosed with cardiovascular disease; 14.3% were diagnosed with hypertension; 1.8% with metabolic syndrome. In this cohort, 14.3% met the criteria for the window of opportunity for preventive measures., Conclusion: A large proportion of women who experienced early-onset preeclampsia had major cardiovascular risk factors in the fifth decade of life, compared with healthy controls. These women are currently outside the scope of most preventive programs due to their relatively young age, but have important modifiable risk factors for cardiovascular diseases., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2017
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48. Effects of tDCS on motor learning and memory formation: A consensus and critical position paper.
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Buch ER, Santarnecchi E, Antal A, Born J, Celnik PA, Classen J, Gerloff C, Hallett M, Hummel FC, Nitsche MA, Pascual-Leone A, Paulus WJ, Reis J, Robertson EM, Rothwell JC, Sandrini M, Schambra HM, Wassermann EM, Ziemann U, and Cohen LG
- Subjects
- Humans, Transcranial Direct Current Stimulation methods, Transcranial Direct Current Stimulation standards, Memory, Motor Skills, Transcranial Direct Current Stimulation adverse effects
- Abstract
Motor skills are required for activities of daily living. Transcranial direct current stimulation (tDCS) applied in association with motor skill learning has been investigated as a tool for enhancing training effects in health and disease. Here, we review the published literature investigating whether tDCS can facilitate the acquisition, retention or adaptation of motor skills. Work in multiple laboratories is underway to develop a mechanistic understanding of tDCS effects on different forms of learning and to optimize stimulation protocols. Efforts are required to improve reproducibility and standardization. Overall, reproducibility remains to be fully tested, effect sizes with present techniques vary over a wide range, and the basis of observed inter-individual variability in tDCS effects is incompletely understood. It is recommended that future studies explicitly state in the Methods the exploratory (hypothesis-generating) or hypothesis-driven (confirmatory) nature of the experimental designs. General research practices could be improved with prospective pre-registration of hypothesis-based investigations, more emphasis on the detailed description of methods (including all pertinent details to enable future modeling of induced current and experimental replication), and use of post-publication open data repositories. A checklist is proposed for reporting tDCS investigations in a way that can improve efforts to assess reproducibility., (Copyright © 2017. Published by Elsevier B.V.)
- Published
- 2017
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49. Racial Tension in Hypertension: Divergent Effects of African and European Ancestry on Cardiac Remodeling.
- Author
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Paulus WJ and Waddingham MT
- Subjects
- Heart, Humans, Hypertrophy, Left Ventricular, Ventricular Remodeling, White People, Heart Failure, Hypertension
- Published
- 2017
- Full Text
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50. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS).
- Author
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Lefaucheur JP, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F, Cotelli M, De Ridder D, Ferrucci R, Langguth B, Marangolo P, Mylius V, Nitsche MA, Padberg F, Palm U, Poulet E, Priori A, Rossi S, Schecklmann M, Vanneste S, Ziemann U, Garcia-Larrea L, and Paulus W
- Subjects
- Brain physiopathology, Europe epidemiology, Evidence-Based Medicine methods, Humans, Nervous System Diseases epidemiology, Nervous System Diseases physiopathology, Randomized Controlled Trials as Topic methods, Transcranial Direct Current Stimulation methods, Evidence-Based Medicine standards, Nervous System Diseases therapy, Practice Guidelines as Topic standards, Transcranial Direct Current Stimulation standards
- Abstract
A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform tDCS in a therapeutic setting. In addition, the easy management and low cost of tDCS devices allow at home use by the patient, but this might raise ethical and legal concerns with regard to potential misuse or overuse. We must be careful to avoid inappropriate applications of this technique by ensuring rigorous training of the professionals and education of the patients., (Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2017
- Full Text
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