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Objective: To investigate whether transcranial direct-current stimulation (tDCS) optimizes the performance of a wheelchair basketball player on precision tasks. Methods: A right-handed wheelchair basketball player (1.5 points functional class) with myelomeningocele (low lumbar level) participated in this case study. The tDCS neuromodulation protocol was applied throughout 10 interventions of 20 minutes with a current intensity of 2 mA, simultaneously with sport-specific training, 3 times a week for 4 weeks. Anodic stimulation was performed on the right cerebellar hemisphere (CB2) and cathodic stimulation in the left dorsolateral prefrontal cortex. A control participant was submitted to a sham-tDCS stimulation protocol for the same period. Functional performance was assessed before the intervention and after the 5th and 10th interventions using "pass accuracy," "free-throw shooting," and "spot shot" tests. Outcome measures were compared using percentage differences between preintervention, intermediate intervention, and postintervention values. Results: There was a gradual increase in the athlete's total and average scores in all tests performed, with an overall improvement of 78% between the baseline and final assessments, while the control participant had an overall improvement of 6.5%. Conclusion: The tDCS protocol was effective in improving performance in precision activities in a wheelchair basketball player. [ABSTRACT FROM AUTHOR]

Introduction: Upper limb motor disability, with a prevalence of approximately 77%, is the most common complication after stroke. Despite advancements in rehabilitation, many patients face persistent upper limb discrepancies. Adopting top-down and bottom-up interventions may enhance neuroplasticity and improve upper limb function. This study aims to determine the effect of motor cortical transcranial direct-current stimulation (tDCS) as a top-down approach combined with task-oriented training (TOT) as a bottom-up intervention on changes in electroencephalography (EEG) spectral power in chronic stroke patients. Materials and Methods: Thirty chronic hemiparetic stroke survivors were randomly assigned to receive real or sham stimulation targeting the primary motor cortex (C3/C4) at 2 mA for 20 minutes and TOT daily over 15 sessions. EEG was conducted before and after the intervention, with a 3-month follow-up and the relative powers of delta to gamma frequency bands were recorded during the movement task with each hand (healthy and involved). Results: Significant differences in the theta (P=0.000), alpha (P=0.004), beta (P=0.000) and gamma (P=0.003) relative powers were observed between groups at follow-up. Additionally, the Friedman test revealed a significant decrease in alpha and beta bands' relative powers in the healthy hand of the control group at follow-up (P=0.001). The experimental group displayed increased alpha and beta powers and decreased theta without statistical significance. Conclusion: The increase in the relative power of low frequencies and the decrease in high frequencies in the sham group, which were more prominent than the increases in alpha and beta bands' relative power and the decrease in theta in the experimental group, can indicate that the real-tDCS can prevent the recovery drop of relative powers. Due to the inconsistent effects of tDCS on the EEG power spectrum in stroke patients, conventional tDCS administration may require adjustments for optimal application to brain target points. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to systematically evaluate the most recent evidence regarding the potential short-term and long-term synergistic effects of transcranial direct-current stimulation (tDCS) and cognitive training (CT) on the memory of individuals with mild cognitive impairment (MCI) or dementia and to explore the optimal treatment protocol. Materials and Methods: Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a comprehensive literature search on PubMed, Medline, CINAHL and EMBASE was conducted to identify eligible randomized controlled trials (RCTs) published up to December 2022. The identified studies were summarized and analyzed to examine the efficacy of the combined intervention. Results: Ten studies involving participants with MCI or dementia were included. Four RCTs with memory-related outcomes were analyzed. A small-to-medium effect size (ES) of 0.28 was found for the short-term effect (95% CI, 0.02%, 0.55%). However, the long-term effect was non-significant, with an ES of 0.17 (95% CI, -0.09%, 0.44%). Conclusion: The combined intervention appears to effectively mitigate cognitive decline in the short term only. Optimal treatment protocol remains inconclusive due to heterogeneity among studies. More robust evidence is required to determine whether the combined approach can serve as an effective intervention in clinical practice. [ABSTRACT FROM AUTHOR]

Victoria A Jackman,1 Krisztina Bajzak,2 Alex Rains,3 Michelle Swab,4 Michelle E Miller,2 Gabrielle S Logan,5 Diana L Gustafson6 1Faculty of Medicine, Memorial University, Newfoundland & Labrador, St. John’s Canada; 2Discipline of Obstetrics and Gynecology, Memorial University, Newfoundland & Labrador, St. John’s Canada; 3Department of Medicine, University of Chicago, Chicago, IL, USA; 4Health Sciences Library, Faculty of Medicine, Memorial University, Newfoundland & Labrador, St. John’s Canada; 5Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; 6Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University, Newfoundland & Labrador, St. John’s CanadaCorrespondence: Krisztina Bajzak, Email kbajzak@yahoo.comIntroduction: Localized provoked vulvodynia (LPV) is a prevalent sexual health condition with significant negative impacts on quality of life. There is a lack of consensus regarding effective management.Methods: We used Arksey and O’Malley’s five-step method to identify, collate, and evaluate literature published between 2010 and 2023. The scoping review investigated the efficacy or effectiveness of interventions in the management of LPV. The aim of this paper is to map the literature on the efficacy or effectiveness of physical interventions.Results: The review produced 19 primary studies of physical interventions for LPV. These include acupuncture, laser therapy, physiotherapy, transcutaneous electrical nerve stimulation, low-intensity shockwave therapy, transcranial direct current stimulation, and vestibulectomy.Conclusion: Published studies that investigated a range of physical treatments for LPV showed some positive effects, except for transcranial direct-current stimulation. The remaining modalities demonstrated improved sexual pain and treatment satisfaction, when measured. Findings were mixed for non-sexual pain. There was insufficient evidence to draw conclusions regarding other outcomes. Researchers are encouraged to conduct larger, high-quality studies that sample more diverse patient populations and use patient-oriented outcomes to assess effectiveness of physical modalities.Keywords: chronic vulvar pain, vestibulodynia, dyspareunia, laser therapy, physiotherapy, physical therapy, acupuncture, vestibulectomy, low-intensity shockwave therapy, transcranial direct-current stimulation, tDCS, transcutaneous electrical nerve stimulation, TENS

First-line treatments for post-traumatic stress disorder (PTSD) encompass a wide range of pharmacotherapies and psychotherapies. However, many patients fail to respond to such interventions, highlighting the need for novel approaches. Due to its ability to modulate cortical activity, non-invasive brain stimulation (NIBS) could represent a valuable therapeutic tool. Therefore, the aim of this systematic review is to summarize and discuss the existing evidence on the ameliorative effects of NIBS on PTSD and comorbid anxiety and depressive symptoms. Our goal is also to debate the effectiveness of an integrated approach characterized by the combination of NIBS and psychotherapy. This search was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines in the PubMed, PsycINFO, PsycARTICLES, PSYINDEX, MEDLINE, and ERIC databases. Overall, 31 studies met the eligibility criteria, yielding a total of 26 clinical trials employing transcranial magnetic stimulation (TMS) and 5 making use of transcranial direct-current stimulation (tDCS). From these studies, it emerged that NIBS consistently reduced overall PTSD symptoms' severity as well as comorbid anxiety and depressive symptoms. Moreover, we speculate that combining NIBS with prolonged exposure or cognitive processing therapy might represent a promising therapeutic approach for consistently ameliorating subjects' clinical conditions. [ABSTRACT FROM AUTHOR]

Abstract Background Motor impairments are very common in neurological diseases such as multiple sclerosis. Noninvasive brain stimulation could influence the motor function of patients. Objective The aim of this meta-analysis was to evaluate the effectiveness of transcranial direct current stimulation (tDCS) on balance and gait ability in patients with multiple sclerosis. Additionally, a secondary aim was to compare the influence of the stimulation location of tDCS on current effectiveness. Methods A search was conducted for randomized controlled trials published up to May 2023 comparing the application of tDCS versus a sham or control group. The primary outcome variables were balance and gait ability. Results Eleven studies were included in the qualitative analysis, and ten were included in the quantitative analysis, which included 230 patients with multiple sclerosis. The average effect of tDCS on gait functionality was superior to that of the control group (SMD = -0.71; 95% CI, -1.05 to -0.37). However, the overall results of the tDCS vs. sham effect on static balance did not show significant differences between groups (MD = 1.26, 95% CI, -1.31 to 3.82). No significant differences were found when different locations of tDCS were compared. Conclusions These results reveal that tDCS is an effective treatment for improving gait ability with a low quality of evidence. However, the application of tDCS has no effect on static balance in patients with multiple sclerosis with very low quality of evidence. Similarly, there seems to be no difference regarding the stimulation area with tDCS.

Complex motor skills can be acquired while observing a model without physical practice. Transcranial direct-current stimulation (tDCS) applied to the primary motor cortex (M1) also facilitates motor learning. However, the effectiveness of observational practice for bimanual coordination skills is debated. We compared the behavioural and brain causal connectivity patterns following three interventions: primary motor cortex stimulation (M1-tDCS), action-observation (AO) and a combined group (AO+M1-tDCS) when acquiring a bimanual, two-ball juggling skill. Thirty healthy young adults with no juggling experience were randomly assigned to either video observation of a skilled juggler, anodal M1-tDCS or video observation combined with M1-tDCS. Thirty trials of juggling were performed and scored after the intervention. Resting-state EEG data were collected before and after the intervention. Information flow rate was applied to EEG source data to measure causal connectivity. The two observation groups were more accurate than the tDCS alone group. In the AO condition, there was strong information exchange from (L) parietal to (R) parietal regions, strong bidirectional information exchange between (R) parietal and (R) occipital regions and an extensive network of activity that was (L) lateralized. The M1-tDCS condition was characterized by bilateral long-range connections with the strongest information exchange from the (R) occipital region to the (R) temporal and (L) occipital regions. AO+M1-tDCS induced strong bidirectional information exchange in occipital and temporal regions in both hemispheres. Uniquely, it was the only condition that was characterized by information exchange between the (R) frontal and central regions. This study provides new results about the distinct network dynamics of stimulating the brain for skill acquisition, providing insights for motor rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Vestibular migraine (VM) is common migraine that occurs in patients with dizziness. Vestibular rehabilitation for managing VM generally remains unclear. Recently, it has been reported that transcranial direct current stimulation (tDCS) has positive effects in alleviating dizziness. This study investigated the effects of tDCS on dizziness and cortical activation in a patient with VM. Methods: We recruited a male patient aged 31 years with no dizziness. The patient watched a video to induce dizziness using a virtual reality device. The study applied the intervention using tDCS for 4 weeks and measured 4 assessments: functional near-infrared spectroscopy (fNIRS), quantitative electroencephalography (qEEG), dizziness handicap inventory, and visual vertigo analog scale. Results: We showed the activation in the middle temporal gyrus and inferior temporal gyrus (ITG) of the left hemisphere and in the superior temporal gyrus and ITG of the right hemisphere in the pre-intervention. After the intervention, the activation of these areas decreased. In the results of qEEG, excessive activation of C3, P3, and T5 in the left hemisphere and C4 in the right hemisphere before intervention disappeared after the intervention. Conclusions: This study indicated that tDCS-based intervention could be considered a viable approach to treating patients with vestibular dysfunction and dizziness caused by VM. [ABSTRACT FROM AUTHOR]

Previous research suggests that applying anodal transcranial direct-current stimulation (tDCS) to the medial-frontal cortex can improve how quickly subjects learn to make simple discriminations (i.e., red from blue). Here, we tested the idea that this enhanced task learning is attributable to superior encoding of relevant information into visual long-term memory. Thirty subjects completed an anodal stimulation session and a sham session, with order counterbalanced across subjects, before performing recognition-memory tasks using pictures of real-world objects and visually presented words or nonwords. These tasks allowed us to detect potential memory differences across types of memoranda. Contrary to the hypothesis that the medial-frontal cortex helps control encoding fidelity, we found that anodal tDCS delivered over this brain region did not significantly improve subjects' memory for visual stimuli, regardless of stimulus type. Our findings show no evidence that targeting medial-frontal cortex with tDCS changes the fidelity of our visual long-term memories. [ABSTRACT FROM AUTHOR]

Abstract Ischemic insult stimulates proliferation of neural stem cells (NSCs) in the subventricular zone (SVZ) after stroke. However, only a fraction of NSC‐derived neuroblasts from SVZ migrate toward poststroke brain region. We have previously reported that direct‐current stimulation guides NSC migration toward the cathode in vitro. Accordingly, we set up a new method of transcranial direct‐current stimulation (tDCS), in which the cathodal electrode is placed on the ischemic hemisphere and anodal electrode on the contralateral hemisphere of rats subjected to ischemia–reperfusion injury. We show that the application of this bilateral tDCS (BtDCS) promotes the migration of NSC‐derived neuroblasts from SVZ toward the cathode direction into poststroke striatum. Reversing the position of the electrodes blocks the effect of BtDCS on the migration of neuroblasts from SVZ. BtDCS protects against neuronal death and improves the functional recovery of stroke animals. Thus, the migration of NSC‐derived neuroblasts from SVZ toward poststroke brain region contributes to the effect of BtDCS against ischemia‐induced neuronal death, supporting a potential development of noninvasive BtDCS as an endogenous neurogenesis‐based stroke therapy.

This study evaluated the efficacy of personalized neuromodulation, where treatment modalities are chosen based on the patient's responses in a pilot trial. A total of 71 patients with tinnitus were divided into two groups: a personalized group and a randomized neuromodulation group. In the personalized group (n = 35), repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS) were assessed in a pilot trial, and responsive modalities were administered to 16 patients, while the non-responders (n = 19) were randomly assigned to rTMS, tDCS, or combined modalities. Patients in the randomized group (n = 36) were randomly allocated to rTMS, tDCS, or combined modalities. The Tinnitus Handicap Inventory (THI) score improvement after 10 sessions of each neuromodulation was significantly greater in the personalized group than in the randomized group (p = 0.043), with no significant differences in tinnitus loudness, distress, or awareness. The treatment success rate was highest in the personalized responder subgroup (92.3%), and significantly greater than that in the non-responder subgroup (53.0%; p = 0.042) and the randomized group (56.7%; p = 0.033). Personalized neuromodulation, where the treatment modality is chosen based on the patient's responses in a pilot trial, is an advantageous strategy for treating tinnitus. [ABSTRACT FROM AUTHOR]

Background: Motor impairments are very common in neurological diseases such as multiple sclerosis. Noninvasive brain stimulation could influence the motor function of patients. Objective: The aim of this meta-analysis was to evaluate the effectiveness of transcranial direct current stimulation (tDCS) on balance and gait ability in patients with multiple sclerosis. Additionally, a secondary aim was to compare the influence of the stimulation location of tDCS on current effectiveness. Methods: A search was conducted for randomized controlled trials published up to May 2023 comparing the application of tDCS versus a sham or control group. The primary outcome variables were balance and gait ability. Results: Eleven studies were included in the qualitative analysis, and ten were included in the quantitative analysis, which included 230 patients with multiple sclerosis. The average effect of tDCS on gait functionality was superior to that of the control group (SMD = -0.71; 95% CI, -1.05 to -0.37). However, the overall results of the tDCS vs. sham effect on static balance did not show significant differences between groups (MD = 1.26, 95% CI, -1.31 to 3.82). No significant differences were found when different locations of tDCS were compared. Conclusions: These results reveal that tDCS is an effective treatment for improving gait ability with a low quality of evidence. However, the application of tDCS has no effect on static balance in patients with multiple sclerosis with very low quality of evidence. Similarly, there seems to be no difference regarding the stimulation area with tDCS. [ABSTRACT FROM AUTHOR]

Objectives: As a major feature of the disease, motor-related complications, including loss of balance and reduced ability to walk were seen in multiple sclerosis (MS). The purpose of this study was to investigate the effect of core stability exercises and transcranial direct-current stimulation (tDCS) as a non-invasive brain stimulation on balance, walking capacity, and quality of life in patients with MS. Methods: In this randomized clinical trial study with a pretest-posttest design, 29 female patients with an Expanded Disability Status Scale (EDSS) of less than 4.5 (3.75±1.31) and a mean age of 38.36±7.99 years were purposefully selected from patients referring to MS society of Tehran during 2021 and then randomly assigned to the following three groups: core stability exercises, anodal tDCS, and sham. Variables, such as balance, walking capacity, and quality of life were measured before and after the interventions. Subjects in the core stability training group participated in core stability exercises for three weeks, and subjects in both sham and anodal tDCS groups received direct brain electrical stimulation for five sessions. Results: A significant improvement in balance and walking capacity were seen both in the anodal tDCS and the core stability training groups (P

Ischemic insult stimulates proliferation of neural stem cells (NSCs) in the subventricular zone (SVZ) after stroke. However, only a fraction of NSC‐derived neuroblasts from SVZ migrate toward poststroke brain region. We have previously reported that direct‐current stimulation guides NSC migration toward the cathode in vitro. Accordingly, we set up a new method of transcranial direct‐current stimulation (tDCS), in which the cathodal electrode is placed on the ischemic hemisphere and anodal electrode on the contralateral hemisphere of rats subjected to ischemia–reperfusion injury. We show that the application of this bilateral tDCS (BtDCS) promotes the migration of NSC‐derived neuroblasts from SVZ toward the cathode direction into poststroke striatum. Reversing the position of the electrodes blocks the effect of BtDCS on the migration of neuroblasts from SVZ. BtDCS protects against neuronal death and improves the functional recovery of stroke animals. Thus, the migration of NSC‐derived neuroblasts from SVZ toward poststroke brain region contributes to the effect of BtDCS against ischemia‐induced neuronal death, supporting a potential development of noninvasive BtDCS as an endogenous neurogenesis‐based stroke therapy. [ABSTRACT FROM AUTHOR]

Introduction: Multiple sclerosis (MS) is a common neurological disorder in societies. The most common symptoms in patients with MS are gait disorders and spasticity. Pharmacological therapies have mild therapeutic influence with more side effects for management of these symptoms. There is evidence that neuro-rehabilitation techniques have more appropriate effects rather than pharmacological therapies. In this regard, some studies indicated the beneficial effects of brain stimulation techniques on gait improvement and decreasing spasticity in patients with MS, while the others have not shown any efficacy. Accordingly, conducting a meta-analysis study in this issue is very important. Methods: A systematic search was performed in PubMed, Scopus, and ISI Web of Science from database inception on December 6, 2020, to find interventional studies assessing the effects of neuromodulators (transcranial direct-current stimulation [tDCS] or transcranial magnetic stimulation [TMS]) on spasticity, balance, and gait in patients with MS. The included studies were qualitatively assessed by the Physiotherapy Evidence Database (PEDro) scale. Finally, the homogeneity studies were analyzed by Stata software. Study-specific results were pooled by using a random-effects model. Results: A total of seven studies were included in the analysis. In the pooled analysis of studies, a significant effect of the TMS technique on spasticity was observed in patients with MS: −0.80 (95% CI: −1.31, −0.29). In addition, no significant effect of the single-session tDCS technique on gait speed was observed in patients with MS: 0.11 (95% CI: −0.11, 0.32). Conclusions: One of the main causes of discrepancy in the findings of included studies is the number of sessions for using neuromodulator techniques. A single session of anodal tDCS is not enough to improve gait in patients with MS. In addition, meta-analysis shows that multi-session TMS is effective intervention for decreasing spasticity in patients with MS. [ABSTRACT FROM AUTHOR]

Background: Interoception, the processing and integration of bodily signals, is crucial for emotional experiences and overall well-being. The interoceptive network, including the somatosensory cortices, has been recognized for its role in interoceptive and emotional processing. High-definition transcranial, direct-current stimulation (HD-tDCS) has been demonstrated to modulate brain activity in the primary somatosensory cortex (S1). Based on those findings, we hypothesized that anodal HD-tDCS over the right S1 would enhance interoceptive abilities and heighten emotional perception. Methods: Thirty-six healthy adults participated in two sessions separated by at least one week. A 20-min HD-tDCS stimulation (2 mA), and a sham stimulation, were applied in randomized order. Both conditions involved pre-tDCS physical activation by ergometer cycling. Interoceptive abilities were assessed before and after both sessions using a heartbeat-perception and respiratory-load task. Emotional perception was measured using four matched international affective picture system (IAPS) picture sets presented randomly. Results: Active HD-tDCS did not significantly improve interoceptive accuracy, interoceptive emotion evaluation, or interoceptive sensibility. However, a notable increase in cardiac interoceptive awareness was observed after active HD-tDCS. The expected enhancement of emotional processing was not observed. Conclusions: This study represents the first attempt to modulate interoceptive and emotional processing using HD-tDCS over S1. Although consistent enhancement was not observed, our findings provide insights into the modulation of interoceptive and emotional processes with HD-tDCS, suggesting avenues for further research. Further studies should consider the nuanced effects of stimulation techniques and the complex interplay between interoception and emotion.

Background: Non-pharmacologic prophylactic methods for chronic migraine have been developed, including the promising non-invasive techniques of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS). This study aimed to compare the efficacy of rTMS and tDCS on pain intensity, the impact of headaches on daily life, anxiety, and depression in migraine headaches patients. Materials and Methods: This randomized clinical trial was conducted on 72 patients with migraine headaches, randomly allocated to the rTMS and tDCS groups. Participants received 3 and 12 sessions of stimulation over the left dorsolateral prefrontal cortex (DLPFC), respectively. Follow-up measurements, including pain intensity, anxiety, depression, and impact on daily life, were performed one month after the last sessions. Analyses were done by IBM SPSS statistics version 26 software. Results: Of 72 patients enrolled in the study, 19 were male (8 in the rTMS group and 11 in the tDCS group). There was no significant difference in baseline characteristics between groups. During the follow-up visit, both groups showed a decrease in anxiety levels (P values = 0.005 and 0.015), while only the rTMS group displayed a significant improvement in depression (P value = 0.01). However, no statistically significant difference was found among the groups regarding changes in pain intensity, anxiety, and the impact of headaches on daily life (P values >0.05). Conclusion: Our findings suggest that both rTMS and tDCS may be effective in reducing pain intensity and improving the impact of headaches on daily life and anxiety in patients with chronic migraine. However, significant improvement in depression was only observed in the rTMS group patients.

Abstract Introduction Post-stroke fatigue (PSF) is an abnormal, persistent, and unexplained physical and psychological tiredness in patients after stroke. It is a common symptom of stroke patients with poor quality of life and bleak prognosis, and the incidence rate is up to 39% to 72%. It has been widely reported that medicine treatments achieved a lot of progress, there still needs to develop more powerful new strategies to more powerful effect. The transcranial direct-current stimulation (tDCS) shows great potential for the treatment of PSF. This study proposes to apply a double-blind randomized controlled clinical trial to explore the effect and safety of tDCS combined with routine rehabilitation for PSF. Methods and analysis One hundred patients with PSF will be randomly divided into two groups. One of the groups will receive conventional rehabilitation therapy and active tDCS, whereas another group will receive conventional rehabilitation treatment and sham tDCS. Both groups will receive the intervention for 4 weeks, during which time they will undergo either active or sham tDCS 20 min a day, 6 days a week. Primary outcome: Fatigue Severity Scale (FSS) will be measured at baseline every weekend during the intervention period. Secondary results: Fatigue Impact Scale (FIS), Functional Assessment Chronic Illness Therapy (Fatigue) (FACIT-F), and Specialized Quality of Life Scale in Stroke (SS-QOL) will be measured at baseline and at the end of the intervention time of 4 weeks. Throughout the study, adverse events and adverse reactions will be measured during every treatment. The research study “Effects of transcranial direct current stimulation on patients with post-stroke fatigue” has been approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University: Clinical Medicine Ethics Review [2015]043 in Nov 2015. Discussion This study will provide insight into the efficacy of transcranial direct-current stimulation for post-stroke fatigue. This is a double-blind randomized controlled trial whose aim is to assess the effects of tDCS on PSF. This study can provide more information about the treatment of PSF. This study has a period of follow-up, which allows for greater accuracy. It is a single-center trial, and this may be a limitation. The other limitation of this study is the relatively small number of participants; thus, the influence of chance on experimental results cannot be completely ruled out. Trial registration Chinese Clinical Trial Registry ChiCTR2000031120 . Registered on March 22, 2020. This protocol version number is V1.1.

Objectives: As a major feature of the disease, motor-related complications, including loss of balance and reduced ability to walk were seen in multiple sclerosis (MS). The purpose of this study was to investigate the effect of core stability exercises and transcranial directcurrent stimulation (tDCS) as a non-invasive brain stimulation on balance, walking capacity, and quality of life in patients with MS. Methods: In this randomized clinical trial study with a pretest-posttest design, 29 female patients with an Expanded Disability Status Scale (EDSS) of less than 4.5 (3.75±1.31) and a mean age of 38.36±7.99 years were purposefully selected from patients referring to MS society of Tehran during 2021 and then randomly assigned to the following three groups: core stability exercises, anodal tDCS, and sham. Variables, such as balance, walking capacity, and quality of life were measured before and after the interventions. Subjects in the core stability training group participated in core stability exercises for three weeks, and subjects in both sham and anodal tDCS groups received direct brain electrical stimulation for five sessions. Results: A significant improvement in balance and walking capacity were seen both in the anodal tDCS and the core stability training groups (P<0.05). Moreover, mobility was significantly changed in the tDCS group (P<0.05). However, no significant difference in the quality of life was seen between the groups. Discussion: Our findings indicate comparable effects of tDCS, and core stability training on balance and walking capacity in patients with MS. Therefore, in addition to exercises, tDCS can be considered a promising tool for the neurorehabilitation of patients with MS. [ABSTRACT FROM AUTHOR]

Abstract Background/aim Opioid use disorder (OUD) can have negative impact on cognitive functions. This study aims to evaluate the effect of bilateral transcranial direct-current stimulation (tDCS) over the right/left dorsolateral prefrontal cortex (DLPFC) on the cognitive abilities of OUD men. Methods This study is a double-blind sham-controlled randomized clinical trial with a pretest/posttest design. Participants were 31 men with OUD living in Zanjan, Iran, assigned to three groups of left anode/right cathode tDCS, right anode/left cathode tDCS, and sham tDCS. The two active groups received tDCS (2 mA) at 10 sessions each for 10–20 min. The Cognitive Abilities Questionnaire (CAQ) in Persian was used to measure their cognitive abilities before and after intervention. Collected data were analyzed in SPSS v.22 software. Results Bilateral DLPFC stimulation resulted in a significant improvement in cognitive flexibility, planning, decision making, inhibitory control/selective attention, and memory of patients in the two active tDCS groups, while the sham tDCS had no significant effect on their cognitive abilities. Conclusion Bilateral tDCS over DLPFC, as an effective and complementary treatment, can improve the cognitive abilities of men with OUD. Trial registration: This study is a double-blind sham-controlled clinical trial (Parallel, IRCT20170513033946N5. Registered 19 Jan 2019, https://en.irct.ir/trial/36081 ).

Transcranial direct stimulation, a non-invasive neurostimulation technique for modulating cortical excitability, and yoga have both respectively been shown to positively affect cognition. While preliminary research has shown that combined transcranial direct stimulation and meditation may have synergistic effects on mood and cognition, this was the first study to explore the combination of transcranial direct stimulation and yoga. Twenty-two healthy volunteers with a regular yoga practice were randomized to receive either active transcranial direct stimulation (anodal left, cathodal right dorsolateral prefrontal cortex) followed by yoga intervention or sham transcranial direct stimulation followed by yoga intervention a double-blind, cross-over design over two separate intervention days. Outcome measures included working memory performance, measured with the n-back task and mindfulness state, measured with the Toronto Mindfulness Scale, and were conducted offline, with pre-post assessments. Twenty participants completed both days of the intervention. Active transcranial direct stimulation did not have a significant effect on working memory or levels of mindfulness. There was a significant placebo effect, with better performance on day 1 of the intervention, irrespective of whether participants received active or sham transcranial direct stimulation. There was no significant difference between active versus sham transcranial direct stimulation concerning working memory performance and mindfulness, which may be accounted by the small sample size, the transient nature of the intervention, the fact that yoga and transcranial direct stimulation concerning were not conducted simultaneously, and the specific site of stimulation.

Objective The aim of this study was to assess the effects of applying transcranial direct-current stimulation (tDCS), a footdrop stimulator (FDS), and gait training simultaneously on functional mobility in people with chronic hemiparesis after stroke. Methods In this double-blind controlled trial, 32 individuals with mild, moderate, and severe chronic hemiparesis after stroke were randomized to tDCS plus FDS or sham tDCS plus FDS groups. Both groups underwent 10 concurrent tDCS and FDS gait training sessions 5 times per week for 2 weeks. Functional mobility was evaluated by the Timed "Up & Go" test (TUG). Secondary outcomes included spasticity of plantarflexors, knee extensors, and hip adductors; quality of life; and walking endurance (distance covered during each treadmill gait training session). Clinical assessments were performed before treatment, after treatment, and at a 1-month follow-up. A generalized estimating equation was used to compare the effects of time, group, and time × group interaction. Results No difference between groups was observed during performance of the TUG or other outcomes. TUG performance was improved in both the tDCS plus FDS group (before treatment = 24.29 [95% CI = 17.72–33.28]; after treatment = 21.75 [95% CI = 15.75–30.08]) and the sham tDCS plus FDS group (before treatment = 19.63 [95% CI = 16.06–23.0]; after treatment = 18.45 [95% CI = 15.26–22.3]). This improvement remained at the follow-up evaluation. Both groups also showed reduced spasticity of plantarflexors and knee extensors, increased quality of life, and increased total distance walked. Conclusion This study provided no evidence that bicephalic tDCS improves functional mobility, spasticity, quality of life, or walking endurance in people with chronic hemiparesis after stroke. Impact Bicephalic tDCS does not add relevant benefits to FDS and gait training in people who have chronic hemiparesis after stroke. Given that tDCS has few additional effects and given its costs for clinical practice, tDCS for rehabilitation in people with chronic hemiparesis after stroke is discouraged. FDS and gait training improve functional mobility, walking resistance, and quality of life in people with chronic hemiparesis after stroke. [ABSTRACT FROM AUTHOR]

Background: The initial phases of robotic surgical skills acquisition are associated with poor technical performance, such as low knot-tensile strength (KTS). Transcranial direct-current stimulation (tDCS) can improve force and accuracy in motor tasks but research in surgery is limited to open and laparoscopic tasks in students. More recently, robotic surgery has gained traction and is now the most common approach for certain procedures (e.g. prostatectomy). Early-phase robotic suturing performance is dependent on prefrontal cortex (PFC) activation, and this study aimed to determine whether performance can be improved with prefrontal tDCS. Methods: Fifteen surgical residents were randomized to either active then sham tDCS or sham then active tDCS, in two counterbalanced sessions in a double-blind crossover study. Within each session, participants performed a robotic suturing task repeated in three blocks: pre-, intra- and post-tDCS. During the intra-tDCS block, participants were randomized to either active tDCS (2 mA for 15 min) to the PFC or sham tDCS. Primary outcome measures of technical quality included KTS and error scores. Results: Significantly faster completion times were observed longitudinally, regardless of active (p < 0.001) or sham stimulation (p < 0.001). KTS was greater following active compared to sham stimulation (median: active = 44.35 N vs. sham = 27.12 N, p < 0.001). A significant reduction in error scores from "pre-" to "post-" (p = 0.029) were only observed in the active group. Conclusion: tDCS could reduce error and enhance KTS during robotic suturing and warrants further exploration as an adjunct to robotic surgical training. [ABSTRACT FROM AUTHOR]

Catatonia is a severe neuropsychiatric syndrome, usually treated by benzodiazepines and electroconvulsive therapy. However, therapeutic alternatives are limited, which is particularly critical in situations of treatment resistance or when electroconvulsive therapy is not available. Transcranial direct-current stimulation (tDCS) is a promising non-invasive neuromodulatory technique that has shown efficacy in other psychiatric conditions. We present the largest case series of tDCS use in catatonia, consisting of eight patients in whom tDCS targeting the left dorsolateral prefrontal cortex and temporoparietal junction was employed. We used a General Linear Mixed Model to isolate the effect of tDCS from other confounding factors such as time (spontaneous evolution) or co-prescriptions. The results indicate that tDCS, in addition to symptomatic pharmacotherapies such as lorazepam, seems to effectively reduce catatonic symptoms. These results corroborate a synthesis of five previous case reports of catatonia treated by tDCS in the literature. However, the specific efficacy of tDCS in catatonia remains to be demonstrated in a randomized controlled trial. The development of therapeutic alternatives in catatonia is of paramount importance. [ABSTRACT FROM AUTHOR]

Introduction: Post-stroke fatigue (PSF) is an abnormal, persistent, and unexplained physical and psychological tiredness in patients after stroke. It is a common symptom of stroke patients with poor quality of life and bleak prognosis, and the incidence rate is up to 39% to 72%. It has been widely reported that medicine treatments achieved a lot of progress, there still needs to develop more powerful new strategies to more powerful effect. The transcranial direct-current stimulation (tDCS) shows great potential for the treatment of PSF. This study proposes to apply a double-blind randomized controlled clinical trial to explore the effect and safety of tDCS combined with routine rehabilitation for PSF.Methods and Analysis: One hundred patients with PSF will be randomly divided into two groups. One of the groups will receive conventional rehabilitation therapy and active tDCS, whereas another group will receive conventional rehabilitation treatment and sham tDCS. Both groups will receive the intervention for 4 weeks, during which time they will undergo either active or sham tDCS 20 min a day, 6 days a week.Primary Outcome: Fatigue Severity Scale (FSS) will be measured at baseline every weekend during the intervention period. Secondary results: Fatigue Impact Scale (FIS), Functional Assessment Chronic Illness Therapy (Fatigue) (FACIT-F), and Specialized Quality of Life Scale in Stroke (SS-QOL) will be measured at baseline and at the end of the intervention time of 4 weeks. Throughout the study, adverse events and adverse reactions will be measured during every treatment. The research study "Effects of transcranial direct current stimulation on patients with post-stroke fatigue" has been approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University: Clinical Medicine Ethics Review [2015]043 in Nov 2015.Discussion: This study will provide insight into the efficacy of transcranial direct-current stimulation for post-stroke fatigue. This is a double-blind randomized controlled trial whose aim is to assess the effects of tDCS on PSF. This study can provide more information about the treatment of PSF. This study has a period of follow-up, which allows for greater accuracy. It is a single-center trial, and this may be a limitation. The other limitation of this study is the relatively small number of participants; thus, the influence of chance on experimental results cannot be completely ruled out.Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031120 . Registered on March 22, 2020. This protocol version number is V1.1. [ABSTRACT FROM AUTHOR]

Bribery is a common form of corruption that takes place when a briber suborns a power holder to achieve an advantageous outcome at the cost of moral transgression. Although bribery has been extensively investigated in the behavioral sciences, its underlying neurobiological basis remains poorly understood. Here, we employed transcranial direct-current stimulation (tDCS) in combination with a novel paradigm (N = 119 adults) to investigate whether disruption of right dorsolateral prefrontal cortex (rDLPFC) causally changed bribe-taking decisions of power holders. Perturbing rDLPFC via tDCS specifically made participants more willing to take bribes as the relative value of the offer increased. This tDCS-induced effect could not be explained by changes in other measures. Model-based analyses further revealed that such neural modulation alters the concern for generating profits for oneself via taking bribes and reshapes the concern for the distribution inequity between oneself and the briber, thereby influencing the subsequent decisions. These findings reveal a causal role of rDLPFC in modulating corrupt behavior. [ABSTRACT FROM AUTHOR]

Background: Studies applying transcranial direct-current stimulation (tDCS) to motor regions to enhance surgical skills have observed modest benefits in performance. Early surgical skills acquisition is known to be dependent on the prefrontal cortex (PFC) which could be a suitable target for performance enhancement in fields with high cognitive demand. Objective: To assess whether prefrontal tDCS could improve early phases of surgical skill development. Methods: In a randomized sham-controlled double-blind parallel design, 40 surgical novices performed an open knot-tying task repeated in three blocks; pre-, online- and post-tDCS. During online stimulation, participants were randomized to either active tDCS (2 mA for 15 min) to the prefrontal cortex (anode over F3, cathode over F4) or sham tDCS. Performance score (PS) was computed using a validated algorithm and introspective workload domains were assessed using a SURG-TLX questionnaire. Results: There was no difference in demographics or PS between groups prior to receiving tDCS. PS significantly improved from pre-to online- (p

Catatonia is a severe neuropsychiatric syndrome, usually treated by benzodiazepines and electroconvulsive therapy. However, therapeutic alternatives are limited, which is particularly critical in situations of treatment resistance or when electroconvulsive therapy is not available. Transcranial direct-current stimulation (tDCS) is a promising non-invasive neuromodulatory technique that has shown efficacy in other psychiatric conditions. We present the largest case series of tDCS use in catatonia, consisting of eight patients in whom tDCS targeting the left dorsolateral prefrontal cortex and temporoparietal junction was employed. We used a General Linear Mixed Model to isolate the effect of tDCS from other confounding factors such as time (spontaneous evolution) or co-prescriptions. The results indicate that tDCS, in addition to symptomatic pharmacotherapies such as lorazepam, seems to effectively reduce catatonic symptoms. These results corroborate a synthesis of five previous case reports of catatonia treated by tDCS in the literature. However, the specific efficacy of tDCS in catatonia remains to be demonstrated in a randomized controlled trial. The development of therapeutic alternatives in catatonia is of paramount importance.

Chronic migraine is a difficult disease to diagnose, and its pathophysiology remains undefined. Its symptoms affect the quality of life and daily living tasks of the affected person, leading to momentary disability. This is a pilot, randomized, controlled, double-blind clinical trial study with female patients between 18 and 65 years old with chronic migraine. The patients underwent twelve mindfulness sessions paired with anodal transcranial direct-current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC), with current intensity of 2 mA applied for 20 min, three times a week for 4 weeks. In addition, 20 min of mindfulness home practices were performed by guided meditation audio files. A total of 30 participants were evaluated after the treatment, and these were subdivided into two groups—active tDCS and sham tDCS, both set to mindfulness practice. The FFMQ-BR (Five Facet of Mindfulness Questionnaire), MIDAS (Migraine Disability Assessment), and HIT-6 (Headache Impact Test) questionnaires were used to evaluate the outcomes. After the treatment, the active mindfulness and tDCS group showed better results in all outcomes. The sham group also showed improvements, but with smaller effect sizes compared to the active group. The only significant difference in the intergroup analysis was the outcome evaluated by HIT-6 in the post treatment result. Our results provide the first therapeutic evidence of mindfulness practices associated with left DLPFC anodal tDCS with a consequent increase in the level of full attention and analgesic benefits in the clinical symptoms of patients with chronic migraine. [ABSTRACT FROM AUTHOR]

Chronic migraine is a difficult disease to diagnose, and its pathophysiology remains undefined. Its symptoms affect the quality of life and daily living tasks of the affected person, leading to momentary disability. This is a pilot, randomized, controlled, double-blind clinical trial study with female patients between 18 and 65 years old with chronic migraine. The patients underwent twelve mindfulness sessions paired with anodal transcranial direct-current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC), with current intensity of 2 mA applied for 20 min, three times a week for 4 weeks. In addition, 20 min of mindfulness home practices were performed by guided meditation audio files. A total of 30 participants were evaluated after the treatment, and these were subdivided into two groups—active tDCS and sham tDCS, both set to mindfulness practice. The FFMQ-BR (Five Facet of Mindfulness Questionnaire), MIDAS (Migraine Disability Assessment), and HIT-6 (Headache Impact Test) questionnaires were used to evaluate the outcomes. After the treatment, the active mindfulness and tDCS group showed better results in all outcomes. The sham group also showed improvements, but with smaller effect sizes compared to the active group. The only significant difference in the intergroup analysis was the outcome evaluated by HIT-6 in the post treatment result. Our results provide the first therapeutic evidence of mindfulness practices associated with left DLPFC anodal tDCS with a consequent increase in the level of full attention and analgesic benefits in the clinical symptoms of patients with chronic migraine.

Background/aim: Opioid use disorder (OUD) can have negative impact on cognitive functions. This study aims to evaluate the effect of bilateral transcranial direct-current stimulation (tDCS) over the right/left dorsolateral prefrontal cortex (DLPFC) on the cognitive abilities of OUD men. Methods: This study is a double-blind sham-controlled randomized clinical trial with a pretest/posttest design. Participants were 31 men with OUD living in Zanjan, Iran, assigned to three groups of left anode/right cathode tDCS, right anode/left cathode tDCS, and sham tDCS. The two active groups received tDCS (2 mA) at 10 sessions each for 10–20 min. The Cognitive Abilities Questionnaire (CAQ) in Persian was used to measure their cognitive abilities before and after intervention. Collected data were analyzed in SPSS v.22 software. Results: Bilateral DLPFC stimulation resulted in a significant improvement in cognitive flexibility, planning, decision making, inhibitory control/selective attention, and memory of patients in the two active tDCS groups, while the sham tDCS had no significant effect on their cognitive abilities. Conclusion: Bilateral tDCS over DLPFC, as an effective and complementary treatment, can improve the cognitive abilities of men with OUD. Trial registration: This study is a double-blind sham-controlled clinical trial (Parallel, IRCT20170513033946N5. Registered 19 Jan 2019, https://en.irct.ir/trial/36081). [ABSTRACT FROM AUTHOR]

Implicit motor sequence learning (IMSL) is affected in Parkinson's disease (PD). Research in healthy young participants shows the potential for transcranial direct‐current stimulation (tDCS) over the primary motor cortex (M1) to enhance IMSL. In PD, only null effects have been reported to date. We determined concurrent, short‐term, and long‐term effects of anodal tDCS over M1 on IMSL, as measured by the serial reaction time (SRT) task, in persons with PD with mild cognitive impairment (MCI). Concurrent (anodal/sham tDCS intervention during the SRT task), short‐term (5 min post‐intervention), and long‐term (1 week post‐intervention) effects on IMSL were evaluated in persons with idiopathic PD (Hoehn and Yahr stage II‐III) with MCI. Results of 11 persons with PD (8 men and 3 women; mean age = 77.1 years; mean disease duration = 7.7 years) showed significant IMSL in the anodal (p =.016), but not in the sham tDCS condition (p =.937). Post‐hoc analyses showed that IMSL reached statistical significance at 1 week post‐intervention (p <.001). Anodal tDCS over M1 exerted beneficial effects on IMSL in persons with PD with MCI, in particular one week post‐intervention. Our study is the first to report a positive effect of tDCS on IMSL in PD. Further research should include a larger, more cognitively diverse sample and additional follow‐up periods. [ABSTRACT FROM AUTHOR]

Abstract Background Transcranial direct-current stimulation (tDCS) is an easy-to-apply, cheap, and safe technique capable of affecting cortical brain activity. However, its effectiveness has not been proven for many clinical applications. Objective The aim of this systematic review was to determine whether the effect of different strategies for gait training in patients with neurological disorders can be enhanced by the combined application of tDCS compared to sham stimulation. Additionally, we attempted to record and analyze tDCS parameters to optimize its efficacy. Methods A search in Pubmed, PEDro, and Cochrane databases was performed to find randomized clinical trials that combined tDCS with gait training. A chronological filter from 2010 to 2018 was applied and only studies with variables that quantified the gait function were included. Results A total of 274 studies were found, of which 25 met the inclusion criteria. Of them, 17 were rejected based on exclusion criteria. Finally, 8 trials were evaluated that included 91 subjects with stroke, 57 suffering from Parkinson’s disease, and 39 with spinal cord injury. Four of the eight assessed studies did not report improved outcomes for any of its variables compared to the placebo treatment. Conclusions There are no conclusive results that confirm that tDCS can enhance the effect of the different strategies for gait training. Further research for specific pathologies, with larger sample sizes and adequate follow-up periods, are required to optimize the existing protocols for applying tDCS.

Abstract Background Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique, which has yielded promising results in treating major depressive disorder. However, its effect on treatment-resistant depression remains to be determined. Meanwhile, as an emerging treatment option, patients’ acceptability of tDCS is worthy of attention. Methods This pilot study enrolled 18 patients (women = 13) with treatment-resistant unipolar (n = 13) or bipolar (n = 5) depression. Twelve sessions of tDCS were administered with anode over F3 and cathode over F4. Each session delivered a current of 2 mA for 30 min per ten working days, and at the 4th and 6th week. Severity of depression was determined by Montgomery–Åsberg Depression Rating Scale (MADRS); cognitive performance was assessed by a computerized battery. Results Scores of MADRS at baseline (29.6, SD = 9.7) decreased significantly to 22.9 (11.7) (p = 0.03) at 6 weeks and 21.5 (10.3) (p = 0.01) at 8 weeks. Six (33.3%) participants were therapeutically responsive to tDCS. MADRS scores of responders were significantly lower than those of non-responders at the 6th and 8th week. Regarding change of cognitive performance, improved accuracy of paired association (p = 0.017) and social cognition (p = 0.047) was observed at the 8th week. Overall, tDCS was perceived as safe and tolerable. For the majority of patients, it is preferred than pharmacotherapy and psychotherapy. Conclusions TDCS can be a desirable option for treatment-resistant depression, however, its efficacy may be delayed; identifying predictors of therapeutic response may achieve a more targeted application. Larger controlled studies with optimized montages and sufficient periods of observation are warranted. Trial registration This trial has been registered at the Chinese Clinical Trial Registry (ChiCTR-INR-16008179).

Introduction: Alcohol use disorder (AUD) ranks among the leading causes of decrements in disability-adjusted life-years. Long-term exposure to alcohol leads to an imbalance of activity between frontal cortical systems and the striatum, thereby enhancing impulsive behaviours and weakening inhibitory control. Alternative therapeutic approaches such as non-invasive and invasive brain stimulation have gained some momentum in the field of addictology by capitalizing on their ability to target specific anatomical structures and correct abnormalities in dysfunctional brain circuits. Materials and methods: The current review, covers original peer-reviewed published research on the use of brain stimulation methods for the rehabilitation of AUD. A broad and systematic search was carried out on four electronic databases: NCBI PubMed, Web of Science, Handbooks and the Cochrane Library. Any original article in English or French language, without restrictions of patient age or gender, article type and publication outlet, were included in the final pool of selected studies. Results: The outcomes of this systematic review suggest that the dorsolateral prefrontral cortex (DLPFC) is a promising target for treating AUD with high frequency repetitive transcranial magnetic stimulation. Such effect would reduce feelings of craving by enhancing cognitive control and modulating striatal function. Existing literature also supports the notion that changes of DLPFC activity driven by transcranial direct current stimulation, could decrease alcohol craving and consumption. However, to date, no major differences have been found between the efficacy of these two non-invasive brain-stimulation approaches, which require further confirmation. In contrast, beneficial stronger evidence supports an impact of deep brain stimulation reducing craving and improving quality of life in AUD, effects that would be mediated by an impact on the nucleus accumbens, a central structure of the brain's reward circuitry. Overall, neurostimulation shows promise contributing to the treatment of AUD. Nonetheless, progress has been limited by a number of factors such as the low number of controlled randomized trials, small sample sizes, variety of stimulation parameters precluding comparability and incomplete or questionable sham-conditions. Additionally, a lack of data concerning clinical impact on the severity of AUD or craving and the short follow up periods precluding and accurate estimation of effect duration after discontinuing the treatment, has also limited the clinical relevance of final outcomes. Conclusion: Brain stimulation remains a promising approach to contribute to AUD therapy, co-adjuvant of more conventional procedures. However, a stronger therapeutic rational based on solid physio-pathological evidence and accurate estimates of efficacy, are still required to achieve further therapeutic success and expand clinical use.

People seek the best in every aspect of life. However, little is known about the neurobiological mechanisms supporting this process of maximization. In this study, maximization tendencies were increased by using high-definition transcranial direct current stimulation (HD-tDCS) over the right dorsolateral prefrontal cortex (DLPFC). Participants (n = 64) received 2 mA anodal 4 × 1 HD-tDCS or sham stimulation over the right DLPFC in two sessions and subsequently completed an N-back working memory task and a maximization scale (MS). We observed that maximization tendency scores increased during anodal stimulation. Furthermore, the results indicate that this increase in maximization tendency was driven by motivational changes. On the MS, alternative search subscale scores were significantly increased, demonstrating an increase in motivation to evaluate more alternatives; however, the results did not indicate that the increase in maximization tendencies was due to working memory improvement. These results demonstrated that maximization tendencies can be strengthened through noninvasive interventions and that the right DLPFC has a causal relationship with maximization tendencies.

• FOG is a complex symptom of PD that still has no effective management therapy. • Non-invasive brain stimulation may have the potential to improve FOG. • A review of neuroimaging has identified several potential cortical regions to target for FOG. • Empirical data shows positive effects of NIBS over M1, SMA and DLPFC on FOG. • PMC, mPFC and PPC are theory-driven candidate regions to consider for NIBS. Freezing of gait (FOG) is a common motor symptom in Parkinson's disease (PD). Although FOG reduces quality of life, affects mobility and increases the risk of falls, there are little to no effective treatments to alleviate FOG. Non-invasive brain stimulation (NIBS) has recently yielded attention as a potential treatment to reduce FOG symptoms however, stimulation parameters and protocols remain inconsistent and require further research. Specifically, targets for stimulation require careful review. Thus, with current neuroimaging and neuro-electrophysiological evidence, we consider potential cortical targets thought to be involved in the pathophysiology of FOG according to the Interference model, and within reach of NIBS. We note that the primary motor cortex, the supplementary motor area and the dorsolateral prefrontal cortex have already drawn attention as NIBS targets for FOG, but based on neuroimaging evidence the premotor cortex, the medial prefrontal cortex, the cerebellum, and more particularly, the posterior parietal cortex should be considered as potential regions for stimulation. We also discuss different methodological considerations, such as stimulation type, medication state, and hemisphere to target, and future perspectives for NIBS protocols in FOG. [ABSTRACT FROM AUTHOR]

People seek the best in every aspect of life. However, little is known about the neurobiological mechanisms supporting this process of maximization. In this study, maximization tendencies were increased by using high-definition transcranial direct current stimulation (HD-tDCS) over the right dorsolateral prefrontal cortex (DLPFC). Participants (n = 64) received 2 mA anodal 4 × 1 HD-tDCS or sham stimulation over the right DLPFC in two sessions and subsequently completed an N-back working memory task and a maximization scale (MS). We observed that maximization tendency scores increased during anodal stimulation. Furthermore, the results indicate that this increase in maximization tendency was driven by motivational changes. On the MS, alternative search subscale scores were significantly increased, demonstrating an increase in motivation to evaluate more alternatives; however, the results did not indicate that the increase in maximization tendencies was due to working memory improvement. These results demonstrated that maximization tendencies can be strengthened through noninvasive interventions and that the right DLPFC has a causal relationship with maximization tendencies. [ABSTRACT FROM AUTHOR]

Transcranial direct-current stimulation (tDCS) has previously demonstrated promising effects in improving surgical performance with motor region stimulation [1–4]. However, extensive prior research has revealed an important role of the prefrontal cortex in surgical skill development [5,6]. This article presents the data of a double-blind randomized sham-controlled trial investigating the effect of prefrontal tDCS on knot-tying performance [7]. Data was collected from an active (n = 20) and sham (n = 20) group across three blocks: pre-, online- (during) and post-tDCS. Group and block differences of knot-tying performance were analyzed using a Generalized linear mixed model and supported with a Friedman's test. Further sub-analyses were conducted to compare high vs. low skilled individuals and initial vs. last knots. Subjective workload was assessed after each block using a SURG-TLX questionnaire and side-effects of the tDCS block were recorded using an additional survey.

Background: There are no head-to-head studies comparing the antidepressant effect of transcranial direct current stimulation (tDCS) with repetitive transcranial magnetic stimulation (rTMS). This pooled analysis compared indirectly the antidepressant efficacy and acceptability of rTMS, tDCS, and the antidepressant venlafaxine (VNF) extended-release. Methods: The analysis (n=117, both patients with treatment-resistant depression (TRD) and non-TRD were included) examined pooled data from two 4-week, single-centered, two-armed, double-blind, randomized studies (EUDRACT n. 2005-000826-22 and EUDRACT n. 2015-001639-19). The antidepressant efficacy of right-sided low-frequency rTMS (n=29) vs VNF (n=31) and left-sided anodal tDCS (n=29) vs VNF (n=28) was evaluated. The primary outcome was a change in the Montgomery–Åsberg Depression Rating Scale (MADRS) score from baseline to the treatment endpoint at week 4. The response was defined as a ≥ 50% reduction in the MADRS score and remission as the MADRS score ≤ 10 points, both were calculated for the primary treatment endpoint at week 4. Results: Mean change in total MADRS scores from baseline to week 4 was 7.0 (95% CI, 4.8– 9.1) points in the rTMS group, 7.6 (95% CI, 5.5– 9.8) in the tDCS group, and 8.9 (95% CI, 7.4– 10.4) among patients in the VNF group, a non-significant difference (F(2111)=0.62, p=0.54). Similarly, neither the response rates nor remission rates for rTMS (response 31%; remission 17%), tDCS (24%, 17%), or VNF (41%; 27%) significantly differed among treatment groups (χ2=2.59, p=0.28; χ2=1.66, p=0.44). Twenty patients (17%) dropped out of the studies in a similar proportion across groups (rTMS 3/29, tDCS 6/29, VNF 11/59, χ2=1.41, p=0.52). Conclusion: Our current analysis found a comparable efficacy and acceptability in all three treatment modalities (rTMS, tDCS, and VNF) and clinical relevance for the acute treatment of major depressive disorder. [ABSTRACT FROM AUTHOR]

Objective: : This study aimed to analyze the effect of the intensified transcranial direct-current stimulation (tDCS) targeting bilateral dorsolateral prefrontal cortex (DLPFC) on craving reduction in patients with opioid use disorder., Methods: : This quasi-experimental study was conducted on 30 individuals who participated voluntarily at Baharan Camp of Shahid Mahalati. The participants had already completed the detoxification phase and stayed at the camp to resolve their craving and gain occupational skills to reintegrate into the community. The participants were selected using convenience and purposive sampling methods and were then assigned to an experimental group (n = 15) and a control group (n = 15). The experimental group received ten 20-minute tDCS sessions twice a day for 5 consecutive days. There was a 20-minute break between the two stimulations. The DLPFC was stimulated with a current intensity of 2 mA (anode: F3 and cathode: F4). The control group received a sham stimulation. Both groups completed Franken's Desires for Drug Questionnaire at baseline and after the stimulation sessions. Additionally, they completed the questionnaires once again three months after the end of the treatment to assess treatment retention., Results: : At the posttest stage, the intensified tDCS had significant effects on momentary opioid craving reduction in all measured factors, e.g., desire and intention, negative reinforcement, and control ( p ＜ 0.001). However, the results concerning treatment retention at the 3-month follow-up stage were insignificant for all factors ( p ＜ 0.001)., Conclusion: : Apparently, tDCS can be used as a tool to reduce craving. However, its application as an independent and sustainable treatment remains debatable.

Transcranial direct-current stimulation (tDCS) of the cerebellum is a promising non-invasive neuromodulatory technique being proposed for the treatment of neurological and neuropsychiatric disorders. However, there is a lack of knowledge about how externally applied currents affect neuronal spiking activity in cerebellar circuits in vivo . We investigated how Cb-tDCS affects the firing rate of Purkinje cells (PC) and non-PC in the mouse cerebellar cortex to understand the underlying mechanisms behind the polarity-dependent modulation of neuronal activity induced by tDCS. Mice (n = 9) were prepared for the chronic recording of LFPs to assess the actual electric field gradient imposed by Cb-tDCS in our experimental design. Single-neuron extracellular recording of PCs in awake (n = 24) and anesthetized (n = 27) mice was combined with juxtacellular recordings and subsequent staining of PC with neurobiotin under anesthesia (n = 8) to correlate their neuronal orientation with their response to Cb-tDCS. Finally, a high-density Neuropixels recording system was used to demonstrate the relevance of neuronal orientation during the application of Cb-tDCS in awake mice (n = 6). In this study, we observe that Cb-tDCS induces a heterogeneous polarity-dependent modulation of the firing rate of Purkinje cells (PC) and non-PC in the mouse cerebellar cortex. We demonstrate that the apparently heterogeneous effects of tDCS on PC activity can be explained by taking into account the somatodendritic orientation relative to the electric field. Our findings highlight the need to consider neuronal orientation and morphology to improve tDCS computational models, enhance stimulation protocol reliability, and optimize effects in both basic and clinical applications., Competing Interests: Declaration of interests: The authors declare no competing financial interests.

Studies applying transcranial direct-current stimulation (tDCS) to motor regions to enhance surgical skills have observed modest benefits in performance. Early surgical skills acquisition is known to be dependent on the prefrontal cortex (PFC) which could be a suitable target for performance enhancement in fields with high cognitive demand. To assess whether prefrontal tDCS could improve early phases of surgical skill development. In a randomized sham-controlled double-blind parallel design, 40 surgical novices performed an open knot-tying task repeated in three blocks; pre-, online- and post-tDCS. During online stimulation, participants were randomized to either active tDCS (2 mA for 15 min) to the prefrontal cortex (anode over F3, cathode over F4) or sham tDCS. Performance score (PS) was computed using a validated algorithm and introspective workload domains were assessed using a SURG-TLX questionnaire. There was no difference in demographics or PS between groups prior to receiving tDCS. PS significantly improved from pre-to online- (p < 0.001) and from pre-to post-tDCS (p < 0.001) in the active group only. Following active tDCS, PS was closer to the defined proficiency benchmark and significantly greater compared to sham (p = 0.002). Only the active group reported significantly improved temporal demand scores from pre-to online- (p = 0.004) to post-tDCS (p = 0.002). This study demonstrates significantly improved early phase surgical-skill acquisition following prefrontal tDCS. Further work is required to determine the underlying neurophysiological mechanisms and whether the benefits observed are retained long-term. • Randomized double-blind trial assessing tDCS in early surgical skill learning. • TDCS significantly improved knot-tying scores compared to baseline and versus sham. • Significantly closer scores to proficiency levels following tDCS compared to sham. • Surgical novices perceived reduced temporal demand following stimulation. [ABSTRACT FROM AUTHOR]

Approximately one-third of elderly people aged over 65 who live in the community experience falls every year, with the proportion increasing with age. Moreover, of those who fall, about half will fall again in the following year. The falls’ consequences include disability, morbidity, and mortality. Although many external and internal factors lead to falls, balance issues play a major role. Multi-component training programs (McTP) usually combine balance, strength, cardiorespiratory fitness, and flexibility, with studies reporting multiple benefits on the health-related quality of life. Halo Sport is a transcranial direct-current stimulation (tDCS) device with promising results for gait performance. This study aims to test the effectiveness of the introduction of a tCDS device to an McTP to prevent falls in older adults. The sample will consist of 46 people aged 65 years or older, randomly assigned to experimental (n = 23) and control (n = 23) groups. The experimental group will perform the McTP while wearing tDCS, and the control group will perform McTP without the device, for three sessions per week over 12 weeks. The main measures will provide information about (1) safety, (2) applicability, (3) balance, (4) number of falls, (5) physical fitness, (6) risk of falling, (7) fear of falling, (8) health-related quality of life, and (9) cognitive function. Among the practical implications of this program, it is intended to provide data on its safety and effectiveness to be implemented in different resources as a tool for the prevention of falls.

Over the recent years, there has been an increasing application of noninvasive brain stimulation techniques such as transcranial direct-current stimulation (tDCS) to modify eating behaviors in healthy population and persons with eating disorders. tDCS is a noninvasive, neuromodulatory intervention which is well-tolerated and safe. In this case report, we describe the successful application of add-on tDCS in a patient with schizophrenia to reduce the craving for food that in turn, helped in reversing the weight gain.