The Efficacy of Transcranial Direct Current Stimulation in Enhancing Surgical Skill Acquisition: A Preliminary Meta-Analysis of Randomized Controlled Trials

Hung, Chao‐Ming; Zeng, Bing‐Yan; Zeng, Bing-Syuan; Sun, Cheuk‐Kwan; Cheng, Yu‐Shian; Su, Kuan‐Pin; Wu, Yi‐Cheng; Chen, Tien‐Yu; Lin, Pao‐Yen; Liang, Chih‐Sung; Hsu, Chih‐Wei; Chu, Che‐Sheng; Chen, Yen‐Wen; Wu, Ming‐Kung; Tseng, Ping‐Tao

doi:10.3390/brainsci11060707

Cited by 17 publications

(24 citation statements)

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“…Indeed, they have demonstrated their efficacy on improving the inhibitor control when targeting PFC, both in healthy and SUD subjects [70][71][72]. It could also be explained by the neural noise hypothesis, according to which tDCS may improve cognitive performance not only through cortical activity modulation but also via modification of the synaptic activity of neurotransmitters in general (such as dopamine, glutamate or serotonin) by activation of various cortices in addition to the targeted ones [73].…”

Section: Discussionmentioning

confidence: 99%

Non‐invasive brain stimulation for smoking cessation: a systematic review and meta‐analysis

et al. 2022

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Background and Aims: Non-invasive brain stimulation (NIBS) methods have showed promising results for the treatment of tobacco use disorder, but little is known about the efficacy of NIBS on sustained tobacco abstinence. We aimed to assess its effectiveness for long-term smoking cessation.Methods: Systematic review and meta-analysis of randomized controlled trials (RCT).PubMed, Cochrane library, Embase, PsycINFO and clinical trials registries were systematically searched for relevant studies up to May 2021. Relevant studies included adult smokers seeking smoking cessation, included in an RCT using NIBS [specifically repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)], and with follow-up of more than 4 weeks. There were no restrictions on location. Abstinence rates in the active NIBS groups were compared with abstinence rates in sham NIBS or in usual treatment groups, from 4 weeks to 12 months following the quit attempt. Smoking abstinence was measured on an intention-to-treat basis and we used risk ratios (RRs) as measures of effect size.Results: Seven studies were included (n = 699 patients). In all included studies, the control groups were receiving sham NIBS and only data from 3 to 6 months were analysable. By pooling the seven included studies, the RR of sustained abstinence of any form of NIBS relative to sham NIBS was 2.39 [95% confidence interval (CI) = 1.26-4.55; I 2 = 40%]. Subgroup analyses found that the RR was even higher when excitatory rTMS was used on the left dorsolateral prefrontal cortex (RR = 4.34; 95% CI = 1.69-11.18; I 2 = 0%) or when using deep rTMS targeting the lateral prefrontal cortex and insula bilaterally (RR = 4.64; 95% CI = 1.61-13.39; I 2 = 0%). A high risk of bias was found in four included studies. We also determined, using grades of recommendation, assessment, development and evaluation, that overall there was a low level of confidence in the results. Conclusion:Non-invasive brain stimulation (NIBS) may improve smoking abstinence rates from 3 to 6 months after quitting smoking, compared with sham NIBS or usual treatment.

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Section: Discussionmentioning

confidence: 99%

Non‐invasive brain stimulation for smoking cessation: a systematic review and meta‐analysis

et al. 2022

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“…The nomenclature and classification of treatment arms were named according to our previous seven NMAs of NIBS in different diseases. 6,[25][26][27][28][29][30] The nomenclature of brain mapping was based on 10-20 EEG mapping (i.e. F3 for left DLPFC, Fp1 for left vmPFC, and F4 for right DLPFC).…”

Section: Data Extractionmentioning

confidence: 99%

Multiple comparison of different noninvasive brain stimulation and pharmacologic interventions in patients with methamphetamine use disorders: A network meta‐analysis of randomized controlled trials

Satogami

Liang

et al. 2022

Psychiatry Clin Neurosci

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Aim: In recent decades, the prevalence of amphetamine and methamphetamine use disorders has at least doubled in some regions/countries, with accompanying high risks of drug overdose-associated mortality. Noninvasive brain stimulation (NIBS) methods may be effective treatments. However, the comparative efficacy of the NIBS protocol for amphetamine/ methamphetamine use disorder (AUD/MUD) remains unknown to date. The aim of this network meta-analysis (NMA) was to compare the efficacy and acceptability of various NIBS methods/protocols for AUD/MUD management.Methods: A frequentist model-based NMA was conducted. We included randomized controlled trials (RCTs) that investigated the efficacy of NIBS and guideline-recommended pharmacologic treatments to reduce craving severity in patients with either AUD or MUD. Results: Twenty-two RCTs including 1888 participants met the eligibility criteria. Compared with the sham/placebo group (study = 19, subjects = 891), a combination of intermittent theta burst stimulation over the left dorsolateral prefrontal cortex (DLPFC) and continuous TBS over the left ventromedial prefrontal cortex (study = 1, subjects = 19) was associated with the largest decreases in craving severity [standardized mean difference (SMD) = À1.50; 95% confidence intervals (95%CIs) = À2.70 to À0.31]. Highfrequency repetitive transcranial magnetic stimulation over the left DLPFC was associated with the largest improvements in depression and quality of sleep (study = 3, subjects = 86) (SMD = À2.48; 95%CIs = À3.25 to À1.71 and SMD = À2.43; 95%CIs = À3.38 to À1.48, respectively).The drop-out rate of most investigated treatments did not significantly differ between groups. Conclusion:The combined TBS protocol over the prefrontal cortex was associated with the greatest improvement in craving severity. Since few studies were available for inclusion, additional large-scale randomized controlled trials are warranted.

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“…Here, neuroplasticity is the ability of the central nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function, and connections. Recently, Hung et al [11] Brain Sci. 2021, 11, 1078 2 of 6 presented the first preliminary meta-analysis of randomized control trials that showed that tDCS was associated with significantly better improvement in surgical performance than the sham control.…”

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confidence: 99%

“…2021, 11, 1078 2 of 6 presented the first preliminary meta-analysis of randomized control trials that showed that tDCS was associated with significantly better improvement in surgical performance than the sham control. Hung et al [11] found that tDCS over the bilateral prefrontal cortex (PFC) and the primary motor cortex (M1) were both associated with significantly better improvements in surgical performance. Since complex motor tasks [12] involve motor control and attention-related brain areas, it is expected that both the PFC and M1 stimulation may facilitate task performance.…”

mentioning

confidence: 99%

“…Since complex motor tasks [12] involve motor control and attention-related brain areas, it is expected that both the PFC and M1 stimulation may facilitate task performance. However, meta-analysis does not address the mechanistic understanding, and Hung et al [11] did not provide further evidence on the mechanism of tDCS action on the learning behavior. Since the tDCS effects on the learning behavior were not analyzed separately at the three stages of learning motor skills: a cognitive phase, an associative phase, and an autonomous phase [13], so all the investigated tDCS montages were found to be facilitatory when lumped together in this preliminary meta-analysis.…”

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confidence: 99%

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Neuroimaging Guided Transcranial Electrical Stimulation in Enhancing Surgical Skill Acquisition. Comment on Hung et al. The Efficacy of Transcranial Direct Current Stimulation in Enhancing Surgical Skill Acquisition: A Preliminary Meta-Analysis of Randomized Controlled Trials. Brain Sci. 2021, 11, 707

2021

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Surgical skill acquisition may be facilitated with a safe application of transcranial direct current stimulation (tDCS). A preliminary meta-analysis of randomized control trials showed that tDCS was associated with significantly better improvement in surgical performance than the sham control; however, meta-analysis does not address the mechanistic understanding. It is known from skill learning studies that the hierarchy of cognitive control shows a rostrocaudal axis in the frontal lobe where a shift from posterior to anterior is postulated to mediate progressively abstract, higher-order control. Therefore, optimizing the transcranial electrical stimulation to target surgical task-related brain activation at different stages of motor learning may provide the causal link to the learning behavior. This comment paper presents the computational approach for neuroimaging guided tDCS based on open-source software pipelines and an open-data of functional near-infrared spectroscopy (fNIRS) for complex motor tasks. We performed an fNIRS-based cortical activation analysis using AtlasViewer software that was used as the target for tDCS of the motor complexity-related brain regions using ROAST software. For future studies on surgical skill training, it is postulated that the higher complexity laparoscopic suturing with intracorporeal knot tying task may result in more robust activation of the motor complexity-related brain areas when compared to the lower complexity laparoscopic tasks.

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The Efficacy of Transcranial Direct Current Stimulation in Enhancing Surgical Skill Acquisition: A Preliminary Meta-Analysis of Randomized Controlled Trials

Cited by 17 publications

References 44 publications

Non‐invasive brain stimulation for smoking cessation: a systematic review and meta‐analysis

Non‐invasive brain stimulation for smoking cessation: a systematic review and meta‐analysis

Multiple comparison of different noninvasive brain stimulation and pharmacologic interventions in patients with methamphetamine use disorders: A network meta‐analysis of randomized controlled trials

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