Toward comprehensive tDCS safety standards

Jackson, Mark; Bikson, Marom; Liebetanz, David; Nitsche, Michael A.

doi:10.1016/j.bbi.2017.08.007

Cited by 11 publications

(7 citation statements)

References 5 publications

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“…These effects were verbally mentioned by the three patients in both stimulation conditions, i.e., anodal and sham tDCS. This good tolerability is in accordance with the known excellent safety profile of tDCS ( Brunoni et al, 2012 ; Bikson et al, 2016 ; Woods et al, 2016 ; Antal et al, 2017 ; Jackson et al, 2017a ; Jackson et al, 2017b ), which is also an important factor to consider this method for treatment in post-stroke patients ( Stagg et al, 2012 ; Gomez Palacio Schjetnan et al, 2013 ; O’Shea et al, 2014 ; Fregni et al, 2015 ; Allman et al, 2016 ; Santos Ferreira et al, 2019 ).…”

Section: Discussionsupporting

confidence: 81%

Bilateral Motor Cortex tDCS Effects on Post-Stroke Pain and Spasticity: A Three Cases Study

et al. 2021

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Stroke patients frequently suffer from chronic limb pain, but well-suited treatment approaches have been not established so far. Transcranial direct current stimulation (tDCS) is a safe and non-invasive brain stimulation technique that alters cortical excitability, and it has been shown that motor cortex tDCS can reduce pain. Some data also suggest that spasticity may be improved by tDCS in post-stroke patients. Moreover, multiple sessions of tDCS have shown to induce neuroplastic changes with lasting beneficial effects in different neurological conditions. The aim of this pilot study was to explore the effect of multiple anodal tDCS (atDCS) sessions on upper limb pain and spasticity of stroke patients, using a within-subject, crossover, sham-controlled design. Brain damage was of similar extent in the three patients evaluated, although located in different hemispheres. The results showed a significant effect of 5 consecutive sessions of atDCS, compared to sham stimulation, on pain evaluated by the Adaptive Visual Analog Scales -AVAS-, and spasticity evaluated by the Fugl-Meyer scale. In two of the patients, pain was completely relieved and markedly reduced, respectively, only after verum tDCS. The pain improvement effect of atDCS in the third patient was considerably lower compared to the other two patients. Spasticity was significantly improved in one of the patients. The treatment was well-tolerated, and no serious adverse effects were reported. These findings suggest that multiple sessions of atDCS are a safe intervention for improving upper limb pain and spasticity in stroke patients, although the inter-individual variability is a limitation of the results. Further studies including longer follow-up periods, more representative patient samples and individualized stimulation protocols are required to demonstrate the efficacy and safety of tDCS for improving limb symptoms in these patients.

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Section: Discussionsupporting

confidence: 81%

Bilateral Motor Cortex tDCS Effects on Post-Stroke Pain and Spasticity: A Three Cases Study

et al. 2021

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“…All rats were stimulated once during experiments. The safety limit of the stimulator was 120 V; current intensity of 800 μA, corresponding to a current density of 32.0 A/m 2 and charge density of 19.2 kC/m 2 in the present setting, was used to maximize the effects of tDCS within the safety limits reported in previous rat tDCS studies ( Liebetanz et al, 2009 ; Jackson et al, 2017 ). We ensured that no abnormal findings regarding cellular morphology were observed in the cortex below the scalp electrode of rats by the stimulation ( Tanaka et al, 2013 ).…”

Section: Methodsmentioning

confidence: 99%

Electrophysiological Effects of Transcranial Direct Current Stimulation on Neural Activity in the Rat Motor Cortex

et al. 2020

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Transcranial direct current stimulation (tDCS) is a non-invasive technique that modulates the neuronal membrane potential. We have previously documented a sustainable increase in extracellular dopamine levels in the rat striatum of cathodal tDCS, suggesting that cathodal tDCS enhances the neuronal excitability of the cortex. In the present study, we investigated changes in neuronal activity in the cerebral cortex induced by tDCS at the point beneath the stimulus electrode in anesthetized rats in vivo . Multiunit recordings were performed to examine changes in neuronal activity before and after the application of tDCS. In the cathodal tDCS group, multiunit activity (indicating the collective firing rate of recorded neuronal populations) increased in the cerebral cortex. Both anodal and cathodal tDCS increased the firing rate of isolated single units in the cerebral cortex. Significant differences in activity were observed immediately following stimulation and persisted for more than an hour after stimulation. The primary finding of this study was that both anodal and cathodal tDCS increased in vivo neuronal activity in the rat cerebral cortex underneath the stimulus electrode.

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“…Throughout the protocol, we surveyed the subjects for subjective sensations like itching, tingling, burning, electric shock-like sensation and also monitored skin redness (through visual observation by the study procedure administrator). We further quantified the severity of perceived sensations (or observation of skin redness) as none (0), mild (1), moderate (2) or severe (3). The time points of the survey were before, during and after pre-skin preparation DCS; during skin preparation procedure; before, during and after post-skin preparation DCS (Table S1).…”

Section: Subjective Sensations Data Collection and Processingmentioning

confidence: 99%

“…However, efficacy is not yet consistent, and there is significant inter‐individual variability in tDCS response. 1 , 2 , 3 One possible reason for this inconsistent response to tDCS in certain subjects is lower ‘delivered dose’ to the brain. In a published meta‐analysis and meta‐regression, we have demonstrated a positive dose–response relationship between tDCS‐related parameters and reduction in post‐stroke upper extremity motor impairment.…”

Section: Introductionmentioning

confidence: 99%

“…With the current human tDCS protocols, safety profiles are good, although skin injuries have been reported. However, efficacy is not yet consistent, and there is significant inter‐individual variability in tDCS response 1–3 . One possible reason for this inconsistent response to tDCS in certain subjects is lower ‘delivered dose’ to the brain.…”

Section: Introductionmentioning

confidence: 99%

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Microdermabrasion facilitates direct current stimulation by lowering skin resistance

Chhatbar

Liu

Ramakrishnan

et al. 2021

Skin Health and Disease

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Background Transcranial direct current stimulation (tDCS) is reported to induce irritating skin sensations and occasional skin injuries, which limits the applied tDCS dose. Additionally, tDCS hardware safety profile prevents high current delivery when skin resistance is high. Objective To test if decreasing skin resistance can enable high‐dose tDCS delivery without increasing tDCS‐related skin sensations or device hardware limits. Methods We compared the effect of microdermabrasion and sonication on 2 mA direct current stimulation (DCS) through forearm skin for 2–3 min on 20 subjects. We also surveyed the subjects using a questionnaire throughout the procedure. We used a linear mixed‐effects model for repeated‐measures and multiple logistic regression, with adjustments for age, race, gender and visit. Results Microdermabrasion, with/out sonication, led to significant decrease in skin resistance (1.6 ± 0.1 kΩ or ∼32% decrease, p < 0.0001). The decrease with sonication alone (0.4 ± 0.1 kΩ or ∼7% decrease, p = 0.0016) was comparable to that of sham (0.3 ± 0.1 kΩ or ∼5% decrease, p = 0.0414). There was no increase in the skin–electrode interface temperature. The perceived DCS‐related sensations did not differ across skin preparation procedures ( p > 0.16), but microdermabrasion (when not combined with sonication) led to increased perceived sensation ( p < 0.01). Conclusions Microdermabrasion (with/out sonication) resulted in reduced skin resistance without increase in perceived skin sensations with DCS. Higher current can be delivered with microdermabrasion‐pre‐treated skin without changing the device hardware while reducing, otherwise higher voltage required to deliver the same amount of current.

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Toward comprehensive tDCS safety standards

Cited by 11 publications

References 5 publications

Bilateral Motor Cortex tDCS Effects on Post-Stroke Pain and Spasticity: A Three Cases Study

Bilateral Motor Cortex tDCS Effects on Post-Stroke Pain and Spasticity: A Three Cases Study

Electrophysiological Effects of Transcranial Direct Current Stimulation on Neural Activity in the Rat Motor Cortex

Microdermabrasion facilitates direct current stimulation by lowering skin resistance

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