Transcranial Direct Current Stimulation in Mesial Temporal Lobe Epilepsy and Hippocampal Sclerosis

San-Juan, Daniel; Lopez, Dulce; Gregorio, Rafael Vázquez; Trenado, Carlos; Aragón, Maricarmen Fernández-González; Morales-Quezada, León; Ruíz, Axel Hernandez; Hernández-González, Flavio; Alcaraz-Guzmán, Alejandro; Anschel, David J.; Fregni, Felipe

doi:10.1016/j.brs.2016.08.013

Cited by 79 publications

(75 citation statements)

References 43 publications

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“…Both clinical trials 33–37 and preclinical studies 3,12,38 suggest prospects for ctDCS in the treatment of epilepsy, but with incomplete seizure suppression and overall inconsistent results 39,40 such that participants remain with seizures (albeit in some trials reduced in frequency) after treatment 37 . In addition to the role of ctDCS parameters (eg, stimulation location, intensity, duration, repetition frequency), which determine clinical efficacy, 39 the inhomogeneous ctDCS aftereffects across the cortex that we demonstrate may contribute to the incomplete clinical effects in trials.…”

Section: Discussionmentioning

confidence: 90%

Drug‐Responsive Inhomogeneous Cortical Modulation by Direct Current Stimulation

Sun

Dhamne

Carretero-Guillén

et al. 2020

Annals of Neurology

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Objective Cathodal direct current stimulation (cDCS) induces long‐term depression (LTD)‐like reduction of cortical excitability (DCS‐LTD), which has been tested in the treatment of epilepsy with modest effects. In part, this may be due to variable cortical neuron orientation relative to the electric field. We tested, in vivo and in vitro, whether DCS‐LTD occurs throughout the cortical thickness, and if not, then whether drug–DCS pairing can enhance the uniformity of the cortical response and the cDCS antiepileptic effect. Methods cDCS‐mediated changes in cortical excitability were measured in vitro in mouse motor cortex (M1) and in human postoperative neocortex, in vivo in mouse somatosensory cortex (S1), and in a mouse kainic acid (KA)‐seizure model. Contributions of N‐methyl‐D‐aspartate–type glutamate receptors (NMDARs) to cDCS‐mediated plasticity were tested with application of NMDAR blockers (memantine/D‐AP5). Results cDCS reliably induced DCS‐LTD in superficial cortical layers, and a long‐term potentiation (LTP)‐like enhancement (DCS‐LTP) was recorded in deep cortical layers. Immunostaining confirmed layer‐specific increase of phospho‐S6 ribosomal protein in mouse M1. Similar nonuniform cDCS aftereffects on cortical excitability were also found in human neocortex in vitro and in S1 of alert mice in vivo. Application of memantine/D‐AP5 either produced a more uniform DCS‐LTD throughout the cortical thickness or at least abolished DCS‐LTP. Moreover, a combination of memantine and cDCS suppressed KA‐induced seizures. Interpretation cDCS aftereffects are not uniform throughout cortical layers, which may explain the incomplete cDCS clinical efficacy. NMDAR antagonists may augment cDCS efficacy in epilepsy and other disorders where regional depression of cortical excitability is desirable. ANN NEUROL 2020;88:489–502

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Section: Discussionmentioning

confidence: 90%

Drug‐Responsive Inhomogeneous Cortical Modulation by Direct Current Stimulation

Sun

Dhamne

Carretero-Guillén

et al. 2020

Annals of Neurology

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“…However, it should also reduce the energetic demands on mitochondria by indirect effects on spiking activity and possibly by direct effects on glia and intracellular bioenergetics . To date, several studies involving patients with refractory focal epilepsy have provided some compelling evidence for the efficacy of tDCS in reducing the frequency of clinical seizures . The technique of tDCS is emerging as a promising noninvasive, nonpharmacological, adjunctive treatment for refractory epilepsy owing to its low risk profile, low cost, and ease of use compared to other surgical neurostimulation techniques such as deep brain stimulation and vagus nerve stimulation.…”

Section: Discussionmentioning

confidence: 99%

The adjunctive application of transcranial direct current stimulation in the management of de novo refractory epilepsia partialis continua in adolescent‐onset POLG‐related mitochondrial disease

Ruiten

Lai

et al. 2018

Epilepsia Open

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SummaryFocal status epilepticus in POLG‐related mitochondrial disease is highly refractory to pharmacological agents, including general anesthesia. We report the challenges in managing a previously healthy teenager who presented with de novo epilepsia partialis continua and metabolic stroke resulting from the homozygous p.Ala467Thr POLG mutation, the most common pathogenic variant identified in the Caucasian population. We applied transcranial direct current stimulation (tDCS; 2 mA; 20 min) daily as an adjunctive therapy because her focal seizures failed to respond to five antiepileptic drugs at maximal doses. The electrical and clinical seizures stopped after 3 days of tDCS. The second course of tDCS was administered for 14 days when the focal seizures re‐emerged a month later. The patient tolerated the procedure well. Following 4 months of hospitalization and prolonged community rehabilitation, our patient has now returned to full‐time education with support, and there is no report of cognitive deficit. We have demonstrated the safety and efficacy of tDCS in treating refractory focal motor seizures caused by mitochondrial disease.

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“…The rationale behind comes from evidence of decreased seizure frequency and interictal discharges, when subjects with focal epilepsy (mesial temporal lobe epilepsy) were exposed to cathodal tDCS. 59 The EEG-tDCS model seems to fit the requirement of a realistic and efficient closed-loop system and, therefore, it is essential to pursue investigations on the potential benefits of NIBS in reducing the risk of seizure using this closed-loop approached.…”

Section: Discussionmentioning

confidence: 99%

Surface EEG-Transcranial Direct Current Stimulation (tDCS) Closed-Loop System

Leite

Morales-Quezada

Carvalho

et al. 2017

Int. J. Neur. Syst.

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Conventional transcranial direct current stimulation (tDCS) protocols rely on applying electrical current at a fixed intensity and duration without using surrogate markers to direct the interventions. This has led to some mixed results; especially because tDCS induced effects may vary depending on the ongoing level of brain activity. Therefore, the objective of this preliminary study was to assess the feasibility of an EEG-triggered tDCS system based on EEG online analysis of its frequency bands. Six healthy volunteers were randomized to participate in a double-blind sham-controlled crossover design to receive a single session of 10min 2mA cathodal and sham tDCS. tDCS trigger controller was based upon an algorithm designed to detect an increase in the relative beta power of more than 200%, accompanied by a decrease of 50% or more in the relative alpha power based on baseline EEG recordings. EEG-tDCS closed-loop-system was able to detect the predefined EEG magnitude deviation and successfully triggered the stimulation in all participants. This preliminary study represents a proof-of-concept for the development of an EEG-tDCS closed-loop system in humans. We discuss and review here different methods of closed loop system that can be considered and potential clinical applications of such system.

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Transcranial Direct Current Stimulation in Mesial Temporal Lobe Epilepsy and Hippocampal Sclerosis

Cited by 79 publications

References 43 publications

Drug‐Responsive Inhomogeneous Cortical Modulation by Direct Current Stimulation

Drug‐Responsive Inhomogeneous Cortical Modulation by Direct Current Stimulation

The adjunctive application of transcranial direct current stimulation in the management of de novo refractory epilepsia partialis continua in adolescent‐onset POLG‐related mitochondrial disease

Surface EEG-Transcranial Direct Current Stimulation (tDCS) Closed-Loop System

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