Automatic M1-SO Montage Headgear for Transcranial Direct Current Stimulation (TDCS) Suitable for Home and High-Throughput In-Clinic Applications

Knotková, Helena; Riggs, Alexa; Berisha, Destiny; Borges, Helen; Bernstein, Henry H.; Patel, Vaishali; Truong, Dennis Q.; Ünal, Gözde; Arce, Denis; Datta, Abhishek; Bikson, Marom

doi:10.1111/ner.12786

Cited by 25 publications

(16 citation statements)

References 43 publications

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“…For example, a head strap can be used to hold the electrodes in place and visual markers can be used by a patient with a mirror to determine proper placement ( Fig. 1A and B) [60]. Electrode preparation and placement completed by users at home may be verified by tDCS technicians through use of live videoconferencing.…”

Section: Device and Electrode Preparation And Placementmentioning

confidence: 99%

Supervised transcranial direct current stimulation (tDCS) at home: A guide for clinical research and practice

et al. 2020

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(tDCS) Remotely supervised tDCS At-home tDCS Best practices in tDCS tDCS safety guide a b s t r a c t Background: Transcranial direct current stimulation (tDCS) is a method of noninvasive neuromodulation and potential therapeutic tool to improve functioning and relieve symptoms across a range of central and peripheral nervous system conditions. Evidence suggests that the effects of tDCS are cumulative with consecutive daily applications needed to achieve clinically meaningful effects. Therefore, there is growing interest in delivering tDCS away from the clinic or research facility, usually at home. Objective: To provide a comprehensive guide to operationalize safe and responsible use of tDCS in home settings for both investigative and clinical use. Methods: Providing treatment at home can improve access and compliance by decreasing the burden of time and travel for patients and their caregivers, as well as to reach those in remote locations and/or living with more advanced disabilities. Results: To date, methodological approaches for at-home tDCS delivery have varied. After implementing the first basic guidelines for at-home tDCS in clinical trials, this work describes a comprehensive guide for facilitating safe and responsible use of tDCS in home settings enabling access for repeated administration over time. Conclusion: These guidelines provide a reference and standard for practice when employing the use of tDCS outside of the clinic setting.

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Section: Device and Electrode Preparation And Placementmentioning

confidence: 99%

Supervised transcranial direct current stimulation (tDCS) at home: A guide for clinical research and practice

et al. 2020

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“…A M1-SO montage was used with anode placed over the left primary motor cortex (C3: EEG 10e20) and cathode placed over the contralateral-supraorbital (Fp2: EEG 10e20) for all treatment conditions. Current was administered for 11 min (including 30 s of ramp up and down each and a 10 min sustained period) using a specialized device (Soterix Medical Inc., New York, USA; Ybrain Inc, Seongnam-si, Republic of Korea) of a tablet-based tDCS stimulator with GUI participant interface, snap-headgear (which ensured placement [29]), and single-use pre-saturated 5 Â 5 cm snap electrodes EasyPad, Soterix Medical Inc., New York, USA).…”

Section: Adaptive 4 Ma Controllermentioning

confidence: 99%

Adaptive current tDCS up to 4 mA

et al. 2020

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Background: Higher tDCS current may putatively enhance efficacy, with tolerability the perceived limiting factor. Objective: We designed and validated electrodes and an adaptive controller to provide tDCS up to 4 mA, while managing tolerability. The adaptive 4 mA controller included incremental ramp up, impedancebased current limits, and a Relax-mode where current is transiently decreased. Relax-mode was automatically activated by self-report VAS-pain score >5 and in some conditions by a Relax-button available to participants. Methods: In a parallel-group participant-blind design with 50 healthy subjects, we used specialized electrodes to administer 3 daily session of tDCS for 11 min, with a lexical decision task as a distractor, in 5 study conditions: adaptive 4 mA, adaptive 4 mA with Relax-button, adaptive 4 mA with historical-Relaxbutton, 2 mA, and sham. A tablet-based stimulator with a participant interface regularly queried VAS pain score and also limited current based on impedance and tolerability. An Abort-button provided in all conditions stopped stimulation. In the adaptive 4 mA with Relax-button and adaptive 4 mA with historical-Relax-button conditions, participants could trigger a Relax-mode ad libitum, in the latter case with incrementally longer current reductions. Primary outcome was the average current delivered during each session, VAS pain score, and adverse event questionnaires. Current delivered was analyzed either excluding or including dropouts who activated Abort (scored as 0 current). Results: There were two dropouts each in the adaptive 4 mA and sham conditions. Resistance based current attenuation was rarely activated, with few automatic VAS pain score triggered relax-modes. In conditions with Relax-button option, there were significant activations often irrespective of VAS pain score. Including dropouts, current across conditions were significantly different from each other with maximum current delivered during adaptive 4 mA with Relax-button. Excluding dropouts, maximum current was delivered with adaptive 4 mA. VAS pain score and adverse events for the sham was only significantly lower than the adaptive 4 mA with Relax-button and adaptive 4 mA with historical-Relaxbutton. There was no difference in VAS pain score or adverse events between 2 mA and adaptive 4 mA. Conclusions: Provided specific electrodes and controllers, adaptive 4 mA tDCS is tolerated and effectively blinded, with acceptability likely higher in a clinical population and absence of regular querying. Indeed, presenting participants with overt controls increases rumination on sensation.

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“…Training should cover sponge preparation, electrode placement, stimulation initiation with ramp up until the target intensity, and standard operating procedures for troubleshooting common problems. Customized head-bands that facilitate electrode positioning and improve compliance could also be provided ( 142 , 220 , 222 ). Parameters used in most clinical trials are similar to what is usually employed in care facility settings ( 220 ).…”

Section: Methodsmentioning

confidence: 99%

Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19

et al. 2020

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Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19.Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders.Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders.Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway.Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.

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Automatic M1-SO Montage Headgear for Transcranial Direct Current Stimulation (TDCS) Suitable for Home and High-Throughput In-Clinic Applications

Cited by 25 publications

References 43 publications

Supervised transcranial direct current stimulation (tDCS) at home: A guide for clinical research and practice

Supervised transcranial direct current stimulation (tDCS) at home: A guide for clinical research and practice

Adaptive current tDCS up to 4 mA

Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19

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Automatic M1-SO Montage Headgear for Transcranial Direct Current Stimulation (TDCS) Suitable for Home and High-Throughput In-Clinic Applications

Cited by 25 publications

References 43 publications

Supervised transcranial direct current stimulation (tDCS) at home: A guide for clinical research and practice

Supervised transcranial direct current stimulation (tDCS) at home: A guide for clinical research and practice

Adaptive current tDCS up to 4 mA

Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19

Contact Info

Product

Resources

About

Adaptive current tDCS up to 4 mA