Proceedings #51: 4 mA Adaptive Transcranial Direct Current Stimulation for Treatment-Resistant Depression: Early Demonstration of Feasibility with a 20-Session Course

Trapp, Nicholas T.; Xiong, Willa; Gott, Britt M.; Espejo, Gemma; Bikson, Marom; Conway, Charles R.

doi:10.1016/j.brs.2018.12.220

Cited by 8 publications

(14 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results show that non-invasive brain stimulation with anodal tDCS up to 4mA is safe and tolerable, although tolerability scores showed a dose effect with higher doses leading to higher scores on the VAS. Our results are in line with the published literature suggesting that current intensity up to 4mA is safe and tolerable (Chhatbar et al, 2017; Dagan et al, 2018; Khadka et al, 2017; Trapp et al, 2019). Further, the current intensity of 4mA is smaller than the predicted lower threshold that might theoretically cause brain damage (Bikson et al, 2016).…”

Section: Discussionsupporting

confidence: 93%

“…Khadka et al showed that the high intensity adaptive tDCS was tolerable in healthy subjects (Khadka et al, 2017). Trapp and colleagues demonstrated 20 session adaptive 4mA tDCS for treatment resistant depression (Trapp et al, 2019), Dagan et al (2018) investigated effects of multitarget tDCS with cumulative dose of 4mA on freezing of gait in patients suffering with Parkinson’s disease (Dagan et al, 2018). Additionally, Bikson and colleagues combined a current threshold value (0.63 mA/cm 2 ) that caused brain damage in rats (Liebetanz et al, 2009) with a rat-to-human scaling factors to predict at what comparable dose level brain damage in humans could occur (Bikson et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Some research studies investigated the safety, tolerability, and efficacy of 4mA dose in healthy adults and patients (Chhatbar et al, 2017; Dagan et al, 2018; Khadka et al, 2017; Trapp et al, 2019). Chhatbar and colleagues carried out a phase I dose escalation study showing safety and tolerability in stroke patients(Chhatbar et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of tDCS Dose and Electrode Montage on regional cerebral blood flow and motor behavior

Shinde

Lerud²,

Munsch³

et al. 2021

Preprint

View full text Add to dashboard Cite

We used three dose levels (Sham, 2mA and 4mA) and two different electrode montages (unihemispheric or bihemispheric) to examine DOSE and MONTAGE effects on regional cerebral blood flow (rCBF) as a surrogate marker of neural activity, and on a finger sequence task, as a surrogate behavioral measure drawing on brain regions targeted by transcranial direct current stimulation (tDCS). We placed the anodal electrode over the right motor region (C4) while the cathodal or return electrode was placed either over a left supraorbital region (unihemispheric montage) or over the left motor region (C3 in the bihemispheric montage). Performance changes in the finger sequence task for both hands (left hand: p = 0.0026, and right hand: p = 0.0002) showed a linear tDCS dose response, but no effect of montage. rCBF in the the right hemispheric perirolandic area increased with dose under the anodal electrode (p = 0.027), while in the perirolandic ROI in the left hemisphere, rCBF showed a trend to increase with dose (p = 0.053), and significant effect of montage (p = 0.00004). The bihemispheric montage showed additional rCBF increases in frontomesial regions in the 4mA condition but not in the 2mA condition. Furthermore, we found correlations between rCBF changes in the right perirolandic region and improvements in the finger sequence task performance (FSP) for left and right hand. Our data support not only a strong direct tDCS dose effect for rCBF and FSP as surrogate measures of targeted brain regions, but also indirect effects on rCBF in functionally connected regions (e.g., frontomesial regions), particularly in the higher dose condition, and on FSP of the ipsilateral hand (to the anodal electrode). At higher dose and irrespective of polarity, a wider network of sensorimotor regions is positively affected by tDCS.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of tDCS Dose and Electrode Montage on regional cerebral blood flow and motor behavior

Shinde

Lerud²,

Munsch³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…This is particularly noteworthy because many of the responders in this study likely would have been classified as non-responders if either of the 'standard' configurations (unilateral) or intensities (2 mA) were used (Figure 2). Fourth, this study adds to the early, but growing, evidence of the tolerability of 4 mA stimulation intensities [29][30][31][52][53][54].…”

Section: Discussionmentioning

confidence: 82%

Cerebellar Transcranial Direct Current Stimulation in People with Parkinson’s Disease: A Pilot Study

et al. 2020

View full text Add to dashboard Cite

People with Parkinson’s disease (PwPD) often experience gait and balance problems that substantially impact their quality of life. Pharmacological, surgical, and rehabilitative treatments have limited effectiveness and many PwPD continue to experience gait and balance impairment. Transcranial direct current stimulation (tDCS) may represent a viable therapeutic adjunct. The effects of lower intensity tDCS (2 mA) over frontal brain areas, in unilateral and bilateral montages, has previously been explored; however, the effects of lower and higher intensity cerebellar tDCS (2 mA and 4 mA, respectively) on gait and balance has not been investigated. Seven PwPD underwent five cerebellar tDCS conditions (sham, unilateral 2 mA, bilateral 2 mA, unilateral 4 mA, and bilateral 4 mA) for 20 min. After a 10 min rest, gait and balance were tested. The results indicated that the bilateral 4 mA cerebellar tDCS condition had a significantly higher Berg Balance Scale score compared to sham. This study provides preliminary evidence that a single session of tDCS over the cerebellum, using a bilateral configuration at a higher intensity (4 mA), significantly improved balance performance. This intensity and cerebellar configuration warrants future investigation in larger samples and over repeated sessions.

show abstract

“…However, the assumption that a higher intensity enhances clinical outcomes in a safe and tolerable manner has not been systematically explored. There are a few that have used intensities >2 mA and have found that 4 mA was safe and well tolerated in stroke survivors [14,16], patients with movement disorders [17], and patients with major depression [18], but each had a very small number of subjects (n < 3). Additionally, a recent report testing an adaptive stimulation controller found that 4 mA tDCS was well tolerated by young adults [19]; however, they did not explore the effects of higher intensity stimulation on a motor task.…”

Section: Introductionmentioning

confidence: 99%

The Tolerability and Efficacy of 4 mA Transcranial Direct Current Stimulation on Leg Muscle Fatigability

2019

View full text Add to dashboard Cite

Transcranial direct current stimulation (tDCS) modulates cortical excitability and affects a variety of outcomes. tDCS at intensities ≤2 mA is well-tolerated, but the tolerability and efficacy of tDCS at intensities >2 mA merits systematic investigation. The study objective was to determine the tolerability and effects of 4 mA tDCS on leg muscle fatigability. Thirty-one young, healthy adults underwent two randomly ordered tDCS conditions (sham, 4 mA) applied before and during an isokinetic fatigue test of the knee extensors and flexors. Subjects reported the severity of the sensations felt from tDCS. Primary outcomes were sensation tolerability and the fatigue index of the knee extensors and flexors. A repeated-measures ANOVA determined statistical significance (p < 0.05). Sensation severity at 4 mA tDCS was not substantially different than sham. However, two subjects reported a moderate–severe headache, which dissipated soon after the stimulation ended. The left knee flexors had significantly greater fatigability with 4 mA tDCS compared with sham (p = 0.018). tDCS at 4 mA was well-tolerated by young, healthy subjects and increased left knee flexor fatigability. Exploration of higher intensity tDCS (>2 mA) to determine the potential benefits of increasing intensity, especially in clinical populations with decreased brain activity/excitability, is warranted.

show abstract

Proceedings #51: 4 mA Adaptive Transcranial Direct Current Stimulation for Treatment-Resistant Depression: Early Demonstration of Feasibility with a 20-Session Course

Cited by 8 publications

References 0 publications

Effects of tDCS Dose and Electrode Montage on regional cerebral blood flow and motor behavior

Effects of tDCS Dose and Electrode Montage on regional cerebral blood flow and motor behavior

Cerebellar Transcranial Direct Current Stimulation in People with Parkinson’s Disease: A Pilot Study

The Tolerability and Efficacy of 4 mA Transcranial Direct Current Stimulation on Leg Muscle Fatigability

Contact Info

Product

Resources

About