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Background Transcranial direct current stimulation (tDCS) is a promising tool to enhance therapeutic efforts, for instance, after a stroke. The achieved stimulation effects exhibit high inter-subject variability, primarily driven by perturbations of the induced electric field (EF). Differences are further elevated in the aging brain due to anatomical changes such as atrophy or lesions. Informing tDCS protocols by computer-based, individualized EF simulations is a suggested measure to mitigate this variability. Objective While brain anatomy in general and specifically atrophy as well as stroke lesions are deemed influential on the EF in simulation studies, the influence of the uncertainty in the change of the electrical properties of the white matter due to white matter lesions (WMLs) has not been quantified yet. Methods A group simulation study with 88 subjects assigned into four groups of increasing lesion load was conducted. Due to the lack of information about the electrical conductivity of WMLs, an uncertainty analysis was employed to quantify the variability in the simulation when choosing an arbitrary conductivity value for the lesioned tissue. Results The contribution of WMLs to the EF variance was on average only one tenth to one thousandth of the contribution of the other modeled tissues. While the contribution of the WMLs significantly increased (p≪.01) in subjects exhibiting a high lesion load compared to low lesion load subjects, typically by a factor of 10 and above, the total variance of the EF did not change with the lesion load. Conclusion Our results suggest that WMLs do not perturb the EF globally and can thus be omitted when modeling subjects with low to medium lesion load. However, for high lesion load subjects, the omission of WMLs may yield less robust local EF estimations in the vicinity of the lesioned tissue. Our results contribute to the efforts of accurate modeling of tDCS for treatment planning.

Background and purposePrevious tDCS studies in chronic stroke patients reported highly inconsistent effects on sensorimotor functions. Underlying reasons could be the selection of different kinematic parameters across studies and for different tDCS setups. We reasoned that tDCS may not simply induce global changes in a beneficial-adverse dichotomy, but rather that different sensorimotor kinematics are differentially affected. Furthermore, the often-postulated higher efficacy of bilateral-dual (bi-tDCS) over unilateral-anodal (ua-tDCS) could not yet be demonstrated consistently either. We investigated the effects of both setups on a wider range of kinematic parameters from standardized robotic tasks in patients with chronic stroke.MethodsTwenty-four patients with arm hemiparesis received tDCS (20min, 1 mA) concurrent to kinematic assessments in a sham-controlled, cross-over and double-blind clinical trial. Performance was measured on four sensorimotor tasks (reaching, proprioception, cooperative and independent bimanual coordination) from which 30 parameters were extracted. On the group-level, the patterns of changes relative to sham were assessed using paired-samples t-tests and classified as (1) performance increases, (2) decreases and (3) non-significant differences. Correlations between parametric change scores were calculated for each task to assess effects on the individual-level.ResultsBoth setups induced complex effect patterns with varying proportions of performance increases and decreases. On the group-level, more increases were induced in the reaching and coordination tasks while proprioception and bimanual cooperation were overall negatively affected. Bi-tDCS induced more performance increases and less decreases compared to ua-tDCS. Changes across parameters occurred more homogeneously under bi-tDCS than ua-tDCS, which induced a larger proportion of performance trade-offs.ConclusionsOur data demonstrate profound tDCS effects on sensorimotor functions post-stroke, lending support for more pronounced and favorable effects of bi-tDCS compared to ua-tDCS. However, no uniformly beneficial pattern was identified. Instead, the modulations varied depending on the task and electrode setup, with increases in certain parameters occurring at the expense of decreases in others.

Decision-making is increasingly being recognised to play a role in learning motor skills. Understanding the neural processes regulating motor decision-making is therefore essential to identify mechanisms that contribute to motor skill learning. In decision-making tasks, the frontopolar cortex (FPC) is involved in tracking the reward of different alternative choices, as well as their reliability. Whether this FPC function extends to reward landscapes associated with a continuous movement dimension remains unknown. Here we used anodal transcranial direct current stimulation (tDCS) over the right FPC to investigate its role in reward-based motor learning. Nineteen healthy human participants completed a motor sequence learning task using trial-wise reward feedback to discover a hidden performance goal along a continuous dimension: timing. As a control condition, we modulated contralateral motor cortex (left M1) activity with tDCS, which has been shown to benefit motor skill learning but less consistently reward-based motor learning. Each active tDCS condition was contrasted to sham stimulation. Right FPC-tDCS led to faster learning primarily through a regulation of exploration, without concurrent modulation of motor noise. A Bayesian computational model revealed that following rFPC-tDCS, participants had a higher expectation of reward, consistent with their faster learning. These higher reward estimates were inferred to be less volatile, and thus participants under rFPC-tDCS deemed the mapping between movement and reward to be more stable. Relative to sham, lM1-tDCS did not significantly modulate main behavioral outcomes. The results indicate that brain regions previously linked to decision-making, such as the FPC, are relevant for motor skill learning.

Simulating transcranial electric stimulation is actively researched as knowledge about the distribution of the electrical field is decisive for understanding the variability in the elicited stimulation effect. Several software pipelines comprehensively solve this task in an automated manner for standard use-cases. However, simulations for non-standard applications such as uncommon electrode shapes or the creation of head models from non-optimized T1-weighted imaging data and the inclusion of irregular structures are more difficult to accomplish.We address these limitations and suggest a comprehensive workflow to simulate transcranial electric stimulation based on open-source tools. The workflow covers the head model creation from MRI data, the electrode modeling, the modeling of anisotropic conductivity behavior of the white matter, the numerical simulation and visualization.Skin, skull, air cavities, cerebrospinal fluid, white matter, and gray matter are segmented semi-automatically from T1-weighted MR images. Electrodes of arbitrary number and shape can be modeled. The meshing of the head model is implemented in a way to preserve feature edges of the electrodes and is free of topological restrictions of the considered structures of the head model. White matter anisotropy can be computed from diffusion-tensor imaging data.Our solver application was verified analytically and by contrasting tDCS simulation results with another simulation pipeline (SimNIBS 3.0). An agreement in both cases underlines the validity of our workflow.Our suggested solutions facilitate investigations of irregular structures in patients (e.g. lesions, implants) or of new electrode types. For a coupled use of the described workflow, we provide documentation and disclose the full source code of the developed tools.

Purpose: Simulating the interaction of the human body with electromagnetic fields is an active field of research. Individualized models are increasingly being used, as anatomical differences affect the simulation results. We introduce a processing pipeline for creating individual surface-based models of the human head and torso for application in simulation software based on unstructured grids. The pipeline is designed for easy applicability and is publicly released on figshare. Methods: The pipeline covers image acquisition, segmentation, generation of segmentation masks, and surface mesh generation of the single, external boundary of each structure of interest. Two gradient-echo sequences are used for image acquisition. Structures of the head and body are segmented using several atlas-based approaches. They consist of bone/skull, subarachnoid cerebrospinal fluid, gray matter, white matter, spinal cord, lungs, the sinuses of the skull, and a combined class of all other structures including skin. After minor manual preparation, segmentation images are processed to segmentation masks, which are binarized images per segmented structure free of misclassified voxels and without an internal boundary. The proposed workflow is applied to 2 healthy subjects. Results: Individual differences of the subjects are well represented. The models are proven to be suitable for simulation of the RF electromagnetic field distribution. Conclusion: Image segmentation, creation of segmentation masks, and surface mesh generation are highly automated. Manual interventions remain for preparing the segmentation images prior to segmentation mask generation. The generated surfaces exhibit a single boundary per structure and are suitable inputs for simulation software.