Crossover design in transcranial direct current stimulation studies on motor learning: potential pitfalls and difficulties in interpretation of findings

Biabani, Mana; Farrell, Michael J.; Zoghi, Maryam; Egan, Gary F.; Jaberzadeh, Shapour

doi:10.1515/revneuro-2017-0056

Cited by 13 publications

(9 citation statements)

References 55 publications

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“…Second, most studies used a crossover design . We opted for a parallel rather than crossover design since the carryover effect of tDCS is still considerably unexplored . Third, while most tDCS studies used left DLPC as target region, we placed the anodal excitability-increasing electrode over the right DLPFC because decreased activation in this region has been reported in adult patients with ADHD during tasks that require attention .…”

Section: Discussionmentioning

confidence: 99%

Transcranial Direct Current Stimulation vs Sham for the Treatment of Inattention in Adults With Attention-Deficit/Hyperactivity Disorder

et al. 2022

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IMPORTANCETranscranial direct current stimulation (tDCS) may improve symptoms of inattention in adults with attention-deficit/hyperactivity disorder (ADHD). However, previous trials are characterized by small sample sizes, heterogeneous methodologies, and short treatment periods using clinic-based tDCS. OBJECTIVE To determine the efficacy and safety of home-based tDCS in treating inattention symptoms in adult patients with ADHD. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, parallel, sham-controlled clinical trial (tDCS for the Treatment of Inattention Symptoms in Adult Patients With ADHD [TUNED]), conducted from July 2019 through July 2021 in a single-center outpatient academic setting. Of 277 potential participants screened by phone, 150 were assessed for eligibility on site, and 64 were included. Participants were adults with ADHD, inattentive or combined subtype. Exclusion criteria included current stimulant drug treatment, current moderate to severe symptoms of depression or anxiety, diagnosis of bipolar disorder with a manic or depressive episode in the last year, diagnosis of schizophrenia or another psychotic disorder, and diagnosis of autism spectrum disorder; 55 of participants completed follow-up after 4 weeks. INTERVENTIONS Thirty-minute daily sessions of home-based tDCS for 4 weeks, 2 mA anodal-right and cathodal-left prefrontal stimulation with 35-cm 2 carbon electrodes. MAIN OUTCOMES AND MEASURES Inattentive scores in the clinician-administered version of the Adult ADHD Self-report Scale version 1.1 (CASRS-I).RESULTS Included in this trial were 64 participants with ADHD (31 [48%] inattentive presentation and 33 [52%] combined presentation), with a mean (SD) age of 38.3 (9.6) years. Thirty participants (47%) were women and 34 (53%) were men. Fifty-five finished the trial. At week 4, the mean (SD) inattention score, as measured with CASRS-I, was 18.88 (5.79) in the active tDCS group and 23.63 (3.97) in the sham tDCS group. Linear mixed-effects models revealed a statistically significant treatment by time interaction for CASRS-I (β interaction = −3.18; 95% CI, −4.60 to −1.75; P < .001), showing decreased symptoms of inattention in the active tDCS group over the 3 assessments compared to the sham tDCS group. Mild adverse events were more frequent in the active tDCS group, particularly skin redness, headache, and scalp burn. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, daily treatment with a home-based tDCS device over 4 weeks improved attention in adult patients with ADHD who were not taking stimulant medication. Home-based tDCS could be a nonpharmacological alternative for patients with ADHD.

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Section: Discussionmentioning

confidence: 99%

Transcranial Direct Current Stimulation vs Sham for the Treatment of Inattention in Adults With Attention-Deficit/Hyperactivity Disorder

et al. 2022

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“…Meanwhile, groups S–A will carry out the opposite protocol (participants will start an allocated 10 sessions of sham tDCS combined with VR tasks, and after a 1 month washout period will be reallocated to 10 sessions of active tDCS combined with VR tasks). The 1 month washout period has been used and was shown to be sufficient to reset the effects of the first 10 sessions in Biabani et al ( 31 ). Figure 2 summarises the planned experimental design.…”

Section: Methodsmentioning

confidence: 99%

Effect of Combined Therapy of Virtual Reality and Transcranial Direct Current Stimulation in Children and Adolescents With Cerebral Palsy: A Study Protocol for a Triple-Blinded Randomized Controlled Crossover Trial

et al. 2020

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Background: Transcranial direct current stimulation (tDCS) and therapy-based virtual reality (VR) have been investigated separately. They have shown promise as efficient and engaging new tools in the neurological rehabilitation of individuals with cerebral palsy (CP). However, the recent literature encourages investigation of the combination of therapy tools in order to potentiate clinic effects and its mechanisms. Methods: A triple-blinded randomised sham-controlled crossover trial will be performed. Thirty-six individuals with gross motor function of levels I to IV (aged 4–14 years old) will be recruited. Individuals will be randomly assigned to Group A (active first) or S (sham first): Group A will start with ten sessions of active tDSC combined with VR tasks. After a 1-month washout, this group will be reallocated to another ten sessions with sham tDCS combined with VR tasks. In contrast, Group S will carry out the opposite protocol, starting with sham tDCS. For the active tDCS the protocol will use low frequency tDCS [intensity of 1 milliampere (mA)] over the primary cortex (M1) area on the dominant side of the brain. Clinical evaluations (reaction times and coincident timing through VR, functional scales: Abilhand-Kids, ACTIVLIM-CP, Paediatric Evaluation of Disability Inventory-PEDI- and heart rate variability-HRV) will be performed at baseline, during, and after active and sham tDCS. Conclusion: tDCS has produced positive results in treating individuals with CP; thus, its combination with new technologies shows promise as a potential mechanism for improving neurological functioning. The results of this study may provide new insights into motor rehabilitation, thereby contributing to the better use of combined tDCS and VR in people with CP. Trial Registration: ClinicalTrials.gov , NCT04044677. Registered on 05 August 2019.

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“…Moreover, given the open gap in the literature on the different biological effects concerning the sham condition [18], in this study we highlighted this comparison in each time period block. Furthermore, the discussion on these findings is related to the existence of a carryover effect between pre/post stimulation versus baseline [24].…”

Section: Statistical Analysesmentioning

confidence: 99%

High Definition tDCS Effect on Postural Control in Healthy Individuals: Entropy Analysis of a Crossover Clinical Trial

et al. 2022

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Objective: Converging evidence supporting an effect of transcranial direct current stimulation (tDCS) on postural control and human verticality perception highlights this strategy as promising for post-stroke rehabilitation. We have previously demonstrated polarity-dependent effects of high-definition tDCS (HD-tDCS) on weight-bearing asymmetry. However, there is no investigation regarding the time-course of effects on postural control induced by HD-tDCS protocols. Thus, we performed a nonlinear time series analysis focusing on the entropy of the ground reaction force as a secondary investigation of our randomized, double-blind, placebo-controlled, crossover clinical trial. Materials and Methods: Twenty healthy right-handed young adults received the following conditions (random order, separate days); anode center HD-tDCS, cathode center HD-tDCS or sham HD-tDCS at 1, 2, and 3 mA over the right temporo-parietal junction (TPJ). Using summarized time series of transfer entropy, we evaluated the exchanging information (causal direction) between both force plates and compared the dose-response across the healthy subjects with a Generalized Linear Hierarchical/Mixed Model (GLMM). Results: We found significant variation during the dynamic information flow (p < 0.001) among the dominant bodyside (and across time). A greater force transfer entropy was observed from the right to the left side during the cathode-center HD-tDCS up to 2 mA, with a causal relationship in the information flow (equilibrium force transfer) from right to left that decreased over time. Conclusions: HD-tDCS intervention induced a dynamic influence over time on postural control entropy. Right hemisphere TPJ stimulation using cathode-center HD-tDCS can induce an asymmetry of body weight distribution towards the ipsilateral side of stimulation. These results support the clinical potential of HD-tDCS for post-stroke rehabilitation.

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Crossover design in transcranial direct current stimulation studies on motor learning: potential pitfalls and difficulties in interpretation of findings

Cited by 13 publications

References 55 publications

Transcranial Direct Current Stimulation vs Sham for the Treatment of Inattention in Adults With Attention-Deficit/Hyperactivity Disorder

Transcranial Direct Current Stimulation vs Sham for the Treatment of Inattention in Adults With Attention-Deficit/Hyperactivity Disorder

Effect of Combined Therapy of Virtual Reality and Transcranial Direct Current Stimulation in Children and Adolescents With Cerebral Palsy: A Study Protocol for a Triple-Blinded Randomized Controlled Crossover Trial

High Definition tDCS Effect on Postural Control in Healthy Individuals: Entropy Analysis of a Crossover Clinical Trial

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