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Objective To systematically review how patient characteristics and/or transcranial direct current stimulation (tDCS) parameters influence tDCS effectiveness in respect to upper limb function post-stroke. Methods Three electronic databases were searched for sham-controlled randomised trials using the Fugl-Meyer Assessment for upper extremity as outcome measure. A meta-analysis and nine subgroup-analyses were performed to identify which tDCS parameters yielded the greatest impact on upper limb function recovery in stroke patients. Results Eighteen high-quality studies (507 patients) were included. tDCS applied in a chronic stage yields greater results than tDCS applied in a (sub)acute stage. Additionally, patients with low baseline upper limb impairments seem to benefit more from tDCS than those with high baseline impairments. Regarding tDCS configuration, all stimulation types led to a significant improvement, but only tDCS applied during therapy, and not before therapy, yielded significant results. A positive dose–response relationship was identified for current/charge density and stimulation duration, but not for number of sessions. Conclusion Our results demonstrate that tDCS improves upper limb function post-stroke. However, its effectiveness depends on numerous factors. Especially chronic stroke patients improved, which is promising as they are typically least amenable to recovery. Significance The current work highlights the importance of several patient-related and protocol-related factors regarding tDCS effectiveness.

uptake after tDCS in the bilateral precentral gyri, the bilateral postcentral gyri, the left cingulate, and the left SMA (p(FWE) < 0.028). These results suggest that perceptions of fatigue and QoL, but not objective performance fatigability, play a prominent role in Post-COVID-19-Fatigue and that tDCS might alter cerebral FDG uptake in fatigue-related brain regions in these patients. Abstract A randomized interventional cross-over trial with transcutaneous auric-ular vagus nerve stimulation (tVNS) was performed on 13 adult Systemic sclerosis (SSc) patients with chronic moderate-to-severe pain from the Scleroderma Unit of Policlinico Hospital in Milan. Patients were randomly assigned to the interventional group with tVNS (25 Hz) or to the control group based on sham stimulation (1 Hz) for 4 not consecutively hours/day for one month. Each group shifted to the opposite arm after a 4-weeks wash-out period. Pain was assessed by Numeric Rating Scale (NRS) and 10-minute ECG was recorded at rest before and after real tVNS and sham. Symbolic Heart Rate Variability (HRV) analysis was performed on ECG to assess the cardiovascular autonomic control. ANCOVA test correcting for baseline values, age, disease duration and month of treatment was used to evaluate NRS or HRV changes after tVNS and sham stimulation. For HRV statistical analysis, cardiac ejection fraction and systolic pulmonary artery pressure were also included as covariates. A linear regression model, correcting for covariates as described above, was performed to evaluate the occurrence of minimal clinically important difference (at least 2 points on NRS). Partial correlation analysis was used to estimate the relationship between NRS and HRV changes after correction for covariates. Statistical analysis showed a significant improvement of NRS score after tVNS with an estimated reduction of 2.051 NRS points (p

Background: Burnout is characterized by deficiencies in attention and several components of the working memory. It has been shown that cognitive behavioral therapy can have a positive effect on burnout and depressive symptoms, however, the lingering effects of impaired attention and executive functions are the most frustrating. We hypothesized that anodal transcranial direct current stimulation (atDCS) over the left dorsolateral prefrontal cortex (DLPFC) can improve the executive control of attention and possibly several other components of working memory in patients with burnout. Methods: This was a randomized double-blind sham-controlled pilot study with two groups. Patients with burnout received three weeks of daily sessions (15 sessions in total) of atDCS or sham stimulation in addition to three weekly sessions of standard behavioral therapy. The primary outcome measure was attention and the central executive of the working memory. Secondary, the effect of atDCS was measured on other components of working memory, on burnout and depression scores, and on quality of life (QoL). Results: We enrolled and randomly assigned 16 patients to a sham or real stimulation group, 15 (7 sham, 8 real) were included in the analysis. atDCS had a significant impact on attention. Post-hoc comparisons also revealed a trend towards more improvement after real tDCS for inhibition and shifting, updating and control, and encoding. Both groups improved on burnout and depression scores. Conclusion: These data provide preliminary evidence for the value of atDCS over the left DLPFC in rehabilitating attention deficits, and possibly also central executive and encoding deficits, in burnout. However, the current study has some limitations, including the sample size and heterogeneous patient population. More elaborate studies are needed to elucidate the specific impact of atDCS over the left DLPFC on burnout. Trial registration: ISRCTN.com ( ISRCTN94275121) 17/11/19

The role of the dorsolateral prefrontal cortex (DLPFC) in the regulation of bimanual coordination appears to become crucial with aging. Age-related changes in the involvement of the DLPFC in bimanual coordination were studied by using disruptive repetitive TMS (rTMS), inducing a transient lesion in this brain structure. Neurophysiological as well as behavioral effects of suppressing DLPFC during the preparation and execution of a bimanual task were studied in 41 healthy adults (young and old). Specifically, we combined short-train rTMS with single pulse TMS to examine the effect of DLPFC suppression on the interhemispheric projection to the contralateral primary motor cortex (M1) during motor preparation. Findings revealed that compromised interhemispheric DLPFC-M1 disinhibition during motor preparation in older adults resulted in less accurate bimanual performance. The altered DLPFC-M1 interaction in older adults appeared to result from a decline in local inhibitory mechanisms in the DLPFC. In addition, the induction of DLPFC suppression affected task accuracy, but not movement stability in both age groups. Taken together, these results suggest that DLPFC acts as a key regulator in the control of bimanual movement coordination.