Guest guest Posted August 10, 2011 Report Share Posted August 10, 2011 how can you be so sure that there is no possibility of potential adverse effects from other areas of the brain being affected by such stimulation in ways we don't yet know or neurodegeneration due to such artificaly induced boosting of neuro transmission? For years I benifited from faster neurotransmission from my occasional coffie drinking. Now, I rarely drink it because I've discovered it causes side effects in me that I was not aware of years ago. Although many people I knew benifitted from TM meditation, some had adverse effects. Bruce Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2011 Report Share Posted August 10, 2011 how can you be so sure that there is no possibility of potential adverse effects from other areas of the brain being affected by such stimulation in ways we don't yet know or neurodegeneration due to such artificaly induced boosting of neuro transmission? For years I benifited from faster neurotransmission from my occasional coffie drinking. Now, I rarely drink it because I've discovered it causes side effects in me that I was not aware of years ago. Although many people I knew benifitted from TM meditation, some had adverse effects. Bruce Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2011 Report Share Posted August 10, 2011 I believe the concept of "excito toxins" is as potentialy relevent for magnetic and electrical stimulation as they are for chemical stimulation. Both electrical and magnetic stimulation also stimulate neurotransmitters. Functional changes involve many key interlocking systems and not just one system. Anything that has the power to move a system in a good direction can also potentialy move it in a bad direction. http://www.sailhome.org/Concerns/Excitotoxins.html Bruce Re: tDCS is safe? how can you be so sure that there is no possibility of potential adverse effects from other areas of the brain being affected by such stimulation in ways we don't yet know or neurodegeneration due to such artificaly induced boosting of neuro transmission? For years I benifited from faster neurotransmission from my occasional coffie drinking. Now, I rarely drink it because I've discovered it causes side effects in me that I was not aware of years ago. Although many people I knew benifitted from TM meditation, some had adverse effects. Bruce Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2011 Report Share Posted August 11, 2011 Doug, Could you compare tDCS efficacy with cranial electric stim devices such as Alpha-Stim or the CES that is built into Dave Siever's auditory-visual entrainment devices?  Sincerely, Levine On Thu, Aug 11, 2011 at 9:48 AM, Dailey <ddailey@...> wrote:  Hello Bruce,  Like usual, you have raised some interesting questions that warrant discussion. Please remember - my opinions are just theories - they are never true or false, but simply either useful or not useful.  Being the well-qualified and busy pri Bactitioner that you are, you are aware that any intersection between ourselves and a client can be potentially hazardous. Even family counseling can have adverse repercussions that effect the health and well-being of several generations. We all take risks, patient and practitioner, in an informed way, if we are convinced, in each particular case, that the benefit outweighs the risk.  I don't know about you, but I have never had a client that was in someone else's scientific study, where the experimental groups were chosen extremely strictly and usually had no comorbidities. Unlike the carefully selected subjects in the restrictive study, our real-life patients have messy complicated lives and are under the influence of multiple confounding factors.  This is why medicine is an art - not a science. Try as we might, we may never fit each client into some statistical distribution of properties required for a controlled study. When we do - then it often becomes " For whom the bell-shaped curve tolls. " I can't even begin to tell you how many times people have been told that there is nothing wrong with them because each of their lab values fits into the plus and minus 2 standard deviations of the distribution seen in 'healthy' people. There are at least three flaws with this time saving (money making) approach. 1) The 'healthy' controls who are sampled are well on their own way to illness and are not followed; 2) just because your level of thyroid hormone (for example) has also been seen in the abstract group of " normals " , it does not follow that it is normal for you; 3) Our clients also differ from any of those in the abstract studies because they are usually receiving several types of other interventions which may include counseling, neuromodulation, medication, herbs and supplements, and toxic exposures at home or at work (not to mention toxic root canals, family history of schizophrenia and bipolar disorder, fibromyalgia, cerebrovascular disease, incipient diabetes and cancer and so forth).  Every client is a mystery with his or her own hidden weaknesses. That is why, I would think, that our prime directive is " First of all - Do no harm. " As you pointed out, since we can't foresee the future, anything we do will have repercussions that continue long after we are gone.  As you also pointed out, even meditation instruction can cause some clients to develop relaxation induced anxiety. Even worse, as Lee Sanella, MD, in his book " Kundalini - Psychosis or Transference? " pointed out, there is a long well-known appreciation in the literature that " meditation illness " is a common and debilitating disorder, often refractory to any treatment.  So let's get back to tDCS. At the very bottom I will give you citations and abstracts for 22 studies on the safety of tDCS. These are more than you are likely to find regarding the safety of neurofeedback. And these are almost all studies done in major universities and published in a wide variety of peer reviewed journals.  Let's look at the studies on tDCS and depression. I have included 22 citations and abstracts on this as well. Among other things, these studies have shown that treatment resistant, suicidal, hospitalized depressive who were given only 5 days of tDCS treatment were shown to do better at 6 week follow-up than similar depressives who responded well to drugs.  There are several 'take home' lessons for me in these studies. One is that all the tDCS protocols for depression used the positive anode at F3 - the dorsolateral prefrontal cortex - exactly where neurofeedback usually targets its influence for depression, an area whose involvement is documented by fMRI and QEEG. The second lesson is that tDCS treats these regions in a way known to mimic normal physiological mechanisms - increasing or decreasing the excitability of neuronal pools by altering the charge difference between the inside and the outside of the neurons. The third lesson is that with tDCS there were no drug side effects and that 5 days of focused tDCS treatment exceeded the results of 6 weeks of daily drug use. In addition, the tDCS brought relief much more quickly than drugs.  Bruce, nobody knows how or if tDCS, neurofeedback, and even, as you mentioned, coffee and meditation, might adversely affect current or future generations. There are many hundreds of studies documenting devastation due to pesticides, genetically modified foods, fragrances, pollution, lack of exercise, neglect, unpredictable stress, and impoverishment. Yet many people will not budge on their lifestyles. Once again it ends up being a risk-benefit analysis, such as we do all the time, and for which, as professionals, we must be constantly educating ourselves.  I will very quickly summarize the tDCS safety information, although I suggest you consult the sources. tDCS can cause a burn to the skin. This rarely occurs because clients will comment if they feel discomfort; but it is a risk for those will lowered skin sensitivity. There were two cases where bipolar depression was lifted but hypomania ensued. That has not occurred since a new electrode montage has become standard. Otherwise, the only 'side effects' are tingling and itching and occasional momentary headache, all of which can be relieved by reducing the current. The investigators could not reduce the current in the studies or the math would have been thrown off - so some subjects had to endure 20 minutes of fire ants on their scalps. In the clinic you set the current for comfort, even if it means you extend your treatment time by a few minutes.  I hope this has helped you answer your question yourself. I believe that I know from our conversations how carefully and strictly you want to use your tools. Otherwise how could we judge our results.  I would be happy to contact you back channel if you are interested in tDCS. Its documented ability to improve cortical glucose tolerance, neuroplasticity, neuroprotection, and learning make it an exceptionally fine tool to use prior to neurofeedback, or simultaneously with HEG and HRV.  I invite you, and any other readers, to join the absolutely new group on tDCStim. At present there are only a handful of members; but it is the only English language tDCS group, and the only active tDCS group anywhere. Being a member will ensure that you will get updates on new studies and that you can talk about tDCS with other experts who have an interest in neurofeedback as well.  Group home page: tDCStim Group email address: tDCStim  Best wishes,  Dailey   ---------------------------- Studies on Depression  J Affect Disord. 2011 Jun 2. Fronto-extracephalic transcranial direct current stimulation as a treatment for major depression: An open-label pilot study. DM, Alonzo A, PB, Sachdev P, Gálvez V, Loo CK. http://www.ncbi.nlm.nih.gov/pubmed/21641047 BACKGROUND: Several recent trials have reported transcranial direct current stimulation (tDCS) to be effective in treating depression, though the relative benefits of different electrode montages remain unexplored. Whereas all recent studies have used a bifrontal (BF) electrode montage, studies published in the 1960s and 1970s placed one electrode in an extracephalic position, with some positive reports of efficacy. This study investigated the efficacy and safety of tDCS given with a fronto-extracephalic (F-EX) montage. METHODS: 2mA tDCS was administered for 20min every weekday over four weeks in 11 participants with a Major Depressive Episode who had previously shown inadequate response to, or relapsed following, a course of BF tDCS. For F-EX tDCS the anode was placed on the left dorsolateral prefrontal cortex and the cathode on the right upper arm. Depression severity and neuropsychological function were assessed before and after the treatment course. Antidepressant response was compared across an equivalent treatment period for both montages. RESULTS: F-EX tDCS was shown to be safe and well tolerated. Depression ratings improved after acute treatment on the Montgomery Åsberg Depression Rating Scale (p<0.001). Participants showed greater initial treatment response with F-EX tDCS than with BF tDCS (p<0.001). LIMITATIONS: This was an open label pilot study. The two comparison treatments were applied consecutively. CONCLUSION: F-EX tDCS appears to be safe and to have antidepressant effects, and may lead to more rapid improvement than tDCS given with a BF montage.  Eur Psychiatry. 2011 May 27. Transcranial direct current stimulation for the outpatient treatment of poor-responder depressed patients. Dell'osso B, Zanoni S, Ferrucci R, Vergari M, Castellano F, D'Urso N, Dobrea C, Benatti B, Arici C, Priori A, Altamura AC. http://www.ncbi.nlm.nih.gov/pubmed/21621982 Transcranial direct current stimulation (tDCS) is a selective, painless, brain stimulation technique that allows the electric stimulation of specific cortical regions. TDCS has been recently used as investigational intervention for major depression and treatment resistant depression (TRD) with encouraging results. The present study was aimed to investigate the efficacy and tolerability of tDCS in major depressives with poor response to pharmacological treatment. Twenty-three depressed patients, with a diagnosis of major depressive disorder or bipolar disorder, were treated with augmentative tDCS for 5 days, two sessions per day in a blind-rater trial. The course of depressive symptoms was analyzed using repeated measures ANOVA for HAM-D and MADRS total scores. A qualitative analysis on the basis of the HAM-D response was performed as well. Both analyses were conducted at three time-points: T0 (baseline), T1 (endpoint tDCS) and T2 (end of the first week of follow-up). All patients completed the trial without relevant side-effects. A significant reduction of HAM-D and MADRS total scores was observed during the study (P<0.0001). Treatment response (endpoint HAM-D reduction ≥50%) was obtained by four patients (17.4%) at T1 and by seven patients (30.4%) at T2 and remission (endpoint HAM-D<8) by three patients (13.0%) at T1 and by four subjects (17.4%) at T2. Present findings support the efficacy and good tolerability of tDCS in the acute treatment of patients with TRD with clinical benefit being progressive and extended to the first week of follow-up. Further sham-controlled trials with longer follow-up are needed to confirm present results.  Neurocase. 2011 Jan 6:1-5. [Epub ahead of print] Mood and cognitive effects of transcranial direct current stimulation in post-stroke depression. Bueno VF, Brunoni AR, Boggio PS, Bensenor IM, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/21213180 Here, we report a patient with significant mood and cognitive impairment who showed marked amelioration of these symptoms following anodal stimulation (2 mA per 30 minutes per 10 days) over the left dorsolateral prefrontal cortex.  Prog Neuropsychopharmacol Biol Psychiatry. 2011 Jan 15;35(1):96-101. Epub 2010 Sep 18. Transcranial direct current stimulation (tDCS) in unipolar vs. bipolar depressive disorder. Brunoni AR, http://www.ncbi.nlm.nih.gov/pubmed/20854868 We applied tDCS over the dorsolateral prefrontal cortex (anodal electrode on the left and cathodal on the right) using a 2 mA-current for 20 min, twice-daily, for 5 consecutive days. Depression was measured at baseline, after 5 tDCS sessions, one week later, and one month after treatment onset. We used the scales of Beck (BDI) and Hamilton-21 items (HDRS). All patients tolerated treatment well without adverse effects. After the fifth tDCS session, depressive symptoms in both study groups diminished, and the beneficial effect persisted at one week and one month. In conclusion, our preliminary study suggests that tDCS is a promising treatment for patients with MDD and BDD.  Neurocase. 2011 Jan 6:1-5. [Epub ahead of print] Mood and cognitive effects of transcranial direct current stimulation in post-stroke depression. Bueno VF, Brunoni AR, Boggio PS, Bensenor IM, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/21213180 " marked amelioration of these symptoms following anodal stimulation (2 mA per 30 minutes per 10 days) over the left dorsolateral prefrontal cortex. "  Int J Neuropsychopharmacol. 2010 Feb;13(1):61-9. Epub 2009 Aug 12. A double-blind, sham-controlled trial of transcranial direct current stimulation for the treatment of depression. Loo CK, Sachdev P, D, Pigot M, Alonzo A, Malhi GS, Lagopoulos J,  P. http://www.ncbi.nlm.nih.gov/pubmed/19671217 N=40; This double-blind, randomized study tested tDCS at the same stimulation parameters as a previous positive study (1 mA current strength, five treatment sessions, active or sham, given on alternate days) in 40 depressed participants. Anodal stimulation was centered over the left dorsolateral prefrontal cortex, with the cathode placed on the lateral aspect of the contralateral orbit. tDCS was continued up to a total of ten active sessions per participant. Overall depression scores improved significantly over ten tDCS treatments... tDCS was found to be safe, with no adverse effects on neuropsychological function, and only minor side-effects.  Arq Neuropsiquiatr. 2010 Jun;68(3):433-51. Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting. Brunoni AR, Teng CT, Correa C, Imamura M, Brasil-Neto JP, Boechat R, M, Caramelli P, Cohen R, Del Porto JA, Boggio PS, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/20602051  J Affect Disord. 2009 Nov;118(1-3):215-9. Epub 2009 Mar 16. Transcranial direct current stimulation in severe, drug-resistant major depression. Ferrucci R, Bortolomasi M, Vergari M, Tadini L, Salvoro B, Giacopuzzi M, Barbieri S, Priori A. http://www.ncbi.nlm.nih.gov/pubmed/19286265 N=14 hospitalized MDD with high suicide risk and referred for ECT. . tDCS was delivered over the dorsolateral prefrontal cortex (DLPC) (2 mA, 20 min, anode left, cathode right) twice a day. After five days of treatment although cognitive performances remained unchanged, the BDI and HDRS scores improved more than 30% (BDI p=0.001; HDRS p=0.017). The mood improvement persisted and even increased at four (T2) weeks after treatment ended. We conclude that frontal tDCS is a simple, promising technique that can be considered in clinical practice as adjuvant treatment for hospitalized patients with severe, drug-resistant major depression.  J Affect Disord. 2009 Oct;117(3):137-45. Epub 2009 Feb 7. Transcranial direct current stimulation: a new tool for the treatment of depression? Arul-Anandam AP, Loo C. http://www.ncbi.nlm.nih.gov/pubmed/19201483 We briefly review tDCS clinical trials for MDD, and then consider its mechanisms of action, identifying potential avenues for future research.  Exp Neurol. 2009 Sep;219(1):14-9. Epub 2009 Apr 5. Treatment of depression with transcranial direct current stimulation (tDCS): a review. Nitsche MA, Boggio PS, Fregni F, Pascual-Leone A. http://www.ncbi.nlm.nih.gov/pubmed/19348793 Major Depression Disorder (MDD) is usually accompanied by alterations of cortical activity and excitability, especially in prefrontal areas. These are reflections of a dysfunction in a distributed cortico-subcortical, bihemispheric network. Early studies from the 1960s suggested some efficacy of DC stimulation to reduce symptoms in depression, but mixed results and development of psychotropic drugs resulted in an early abandonment of this technique. In the last years tDCS protocols have been optimized. Application of the newly developed stimulation protocols in patients with major depression has shown promise in few pilot studies.  Curr Opin Psychiatry. 2009 May;22(3):306-11. Transcranial direct current stimulation as a therapeutic tool for the treatment of major depression: insights from past and recent clinical studies. DN, Boggio P, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/19339889 tDCS is associated with significant clinical gains. ... it appears that current methods of tDCS might not be fully optimized and, in fact, (1) individualized parameters of stimulation, (2) longer stimulation sessions, and (3) methods to focalize tDCS might be useful strategies to provide greater clinical benefits.  Rev Bras Psiquiatr. 2009 May;31 Suppl 1:S34-8. Transcranial direct current stimulation: a promising alternative for the treatment of major depression? Berlim MT, Dias Neto V, Turecki G. http://www.ncbi.nlm.nih.gov/pubmed/19565150 Current protocols for the treatment of major depression with transcranial direct current stimulation usually involve the application of two sponge-electrodes in the scalp. In general, the positive electrode is applied in the region above the left dorsolateral prefrontal cortex (i.e., F3 region of the 10/20 International System for EEG) and the negative electrode is applied in the region above the right supra-orbital area. A direct electrical current of 1-2 mA is then applied between the electrodes for about 20 minutes, with sessions being daily performed for one to two weeks. Recent studies show that transcranial direct current stimulation is an important neuromodulatory method that may be useful for the treatment of depressed patients.  Ther Clin Risk Manag. 2009;5:897-910. Epub 2009 Nov 18. Pharmacological and combined interventions for the acute depressive episode: focus on efficacy and tolerability. Brunoni AR, Fraguas R, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/19956554 A search was undertaken in MEDLINE, Web of Science, Cochrane, and Scielo databases. We included: 21 meta-analyses of antidepressant trials, 15 neurostimulation clinical trials and 8 studies of pharmacoeconomics. These therapies might be interesting augmentation strategies, considering their benign profile of side effects, if proper safety parameters are adopted.  World J Biol Psychiatry. 2009;10(4 Pt 2):632-5. Transcranial direct current stimulation in a patient with therapy-resistant major depression. Palm U, Keeser D, Schiller C, Fintescu Z, Reisinger E, Baghai TC, Mulert C, Padberg F. http://www.ncbi.nlm.nih.gov/pubmed/19995213 N=1; female patient suffering from recurrent major depressive episodes who underwent anodal tDCS of the left dorsolateral PFC over 4 weeks as an add-on treatment. Only a modest improvement of depressive symptoms was observed after tDCS,... However, there was an increase from 52 to 90% in the Regensburg Verbal Fluency Test. Low resolution brain electromagnetic tomography (LORETA) showed a left unilateral focal effect (25-40% reduced power) in the delta, theta and alpha frequency bands. The same effect appeared in the surface analysis of the EEG. The absolute, as well as the relative power decreased significantly in the delta, theta and alpha bands after a comparison of the spectral analysis.  Curr Psychiatry Rep. 2008 Dec;10(6):465-73. Novel targets for antidepressant therapies. Holtzheimer PE, Nemeroff CB. http://www.ncbi.nlm.nih.gov/pubmed/18980729  Curr Treat Options Neurol. 2008 Sep;10(5):377-85. Transcranial direct current stimulation for major depression: a general system for quantifying transcranial electrotherapy dosage. Bikson M, Bulow P, Stiller JW, Datta A, Battaglia F, Karnup SV, Postolache TT. http://www.ncbi.nlm.nih.gov/pubmed/18782510 If tDCS can be established as an effective treatment for depression, it would represent a particularly attractive electrotherapy option, as it is a relatively benign and affordable treatment modality. An accurate system for describing reproducible treatment parameters is essential so that further studies can yield evidence-based guidelines for the clinical use of transcranial current stimulation  Int J Neuropsychopharmacol. 2008 Mar;11(2):249-54. Epub 2007 Jun 11. A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. Boggio PS, Rigonatti SP, Ribeiro RB, Myczkowski ML, Nitsche MA, Pascual-Leone A, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/17559710 N=40; 10 sessions over a 2 week period of anodal tDCS to the left dorsolateral prefrontal cortex lead to " significantly larger reductions in depression scores after DLPFC tDCS. ...The beneficial effects of tDCS in the DLPFC group persisted for 1 month after the end of treatment  Eur Psychiatry. 2008 Jan;23(1):74-6. Epub 2007 Nov 19. Transcranial direct stimulation and fluoxetine for the treatment of depression. Rigonatti SP, Boggio PS, Myczkowski ML, Otta E, Fiquer JT, Ribeiro RB, Nitsche MA, Pascual-Leone A, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/18023968 N=42; Patients were moderately depressed, off medication for two month. We compared the findings of a parallel-group, randomized, double-blind clinical trial investigating the effects of active vs. sham tDCS with an open-label trial in which patients with similar clinical characteristics received fluoxetine, a frequently prescribed serotonin reuptake inhibitor.Protocol: 2 mA of intensity for 20 min for 10 days (anodal electrode on the left dorsolateral prefrontal cortex and cathode electrode on the contralateral supraorbital area). All patients were assessed at baseline and after 2, 4, and 6 weeks after the onset of treatment (tDCS or fluoxetine). Results: the antidepressant effects of non-invasive brain stimulation with tDCS are similar to those of a 6-week course of fluoxetine at a relatively small dose of 20 mg/day. However, the antidepressant benefit of tDCS appears to become significant faster than the benefit of fluoxetine.  J Affect Disord. 2007 Aug;101(1-3):91-8. Epub 2006 Dec 12. Go-no-go task performance improvement after anodal transcranial DC stimulation of the left dorsolateral prefrontal cortex in major depression. Boggio PS, Bermpohl F, Vergara AO, Muniz AL, Nahas FH, Leme PB, Rigonatti SP, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/17166593 ....anodal stimulation of the left DLPFC was the only condition that induced a significant improvement in task performance as shown by the increase in the number of correct responses. In addition, this effect was specific for figures with positive emotional content. This performance enhancement was not correlated with mood changes after 10 days of tDCS treatment.  Clin EEG Neurosci. 2007 Apr;38(2):105-15. Transcranial and deep brain stimulation approaches as treatment for depression. Rau A, Grossheinrich N, Palm U, Pogarell O, Padberg F. http://www.ncbi.nlm.nih.gov/pubmed/17515176 Several brain stimulation approaches are currently being investigated as novel therapeutic interventions beside electroconvulsive therapy (ECT), a prototypic method in this field with proven effectiveness. These neurostimulation methods include repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST), vagus nerve stimulation (VNS), deep brain stimulation (DBS) and transcranial direct current stimulation (tDCS). It is via different neuroanatomically defined " windows " that the various approaches access the neuronal networks showing an altered function in depression. Also, the methods vary regarding their degree of invasiveness. One or the other method may finally achieve antidepressant effectiveness with minimized side effects and constitute a new effective treatment for major depression.  Bipolar Disord. 2006 Apr;8(2):203-4. Treatment of major depression with transcranial direct current stimulation. Fregni F, Boggio PS, Nitsche MA, Marcolin MA, Rigonatti SP, Pascual-Leone A. http://www.ncbi.nlm.nih.gov/pubmed/16542193 N=10; tDCS was applied through a saline-soaked pair of surface sponge electrodes (35 cm2). The anode electrode was placed over F3 (10–20 International EEG System) of each subject. The cathode was placed over the contralateral supraorbital area. A constant current of 1 mA strength was applied for 20 min/day (administered for five alternated days). All patients tolerated tDCS without complications. At the end of treatment, there were four treatment responders in the active group versus no responders in the sham group. This treatment is inexpensive, easy to administer, non-invasive and painless.  Depress Anxiety. 2006;23(8):482-4. Cognitive effects of repeated sessions of transcranial direct current stimulation in patients with depression. Fregni F, Boggio PS, Nitsche MA, Rigonatti SP, Pascual-Leone A. http://www.ncbi.nlm.nih.gov/pubmed/16845648 The clinical utility of transcranial direct current stimulation (tDCS) has been discussed and explored for almost 40 years....recent investigations using different electrodes size and position, and different stimulation parameters have demonstrated that this technique is a robust method to modulate brain excitability probably on the basis of shifts in neuronal membrane excitability in patients with major depression. In this trial, we investigated the cognitive effects of 5 days of anodal stimulation of the left DLPFC in 18 patients with major depression. A neuropsychological battery was assessed immediately before the first day of treatment and immediately after the last treatment day (fifth session). The anode electrode was placed over F3 (10–20 International EEG System) of each subject. The cathode (reference electrode) was placed over the contralateral supraorbital area. A constant current of 1-mA strength was applied for 20 minutes per day (administered for 5 alternate days) during the morning (8:00 to 10:00 A.M.). Repeated sessions of active tDCS do not result in cognitive impairment compared to placebo tDCS in patients with major depression; on the contrary, they appear able to improve one aspect of cognitive function—working memory. This cognitive enhancement was not observed after sham tDCS and was not correlated with mood effects. This is in line with a previous study that showed an enhancement of working memory after a single session of tDCS of the left DLPFC in healthy subjects   --------------------------- Studies on Safety  Biol Psychiatry. 2011 Apr 15;69(8):e23-4. Epub 2011 Feb 18. Efficacy and safety of transcranial direct current stimulation in major depression. Dell'osso B, Priori A, Altamura AC. http://www.ncbi.nlm.nih.gov/pubmed/21310394  Int J Neuropsychopharmacol. 2011 Feb 15:1-13. [Epub ahead of print] A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. Brunoni AR, Amadera J, Berbel B, Volz MS, Rizzerio BG, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/21320389  J ECT. 2011 Jan 4. [Epub ahead of print] Hypomania Induction in a Patient With Bipolar II Disorder by Transcranial Direct Current Stimulation (tDCS). Gálvez V, Alonzo A, D, PB, Sachdev P, Loo CK. http://www.ncbi.nlm.nih.gov/pubmed/21206371 participated in a clinical trial of tDCS given with a bifrontal electrode montage for the treatment of major depression without incident, but became hypomanic when she received a later course of tDCS given with a frontoextracephalic configuration.  Int J Neuropsychopharmacol. 2011 Apr;14(3):425-6. Epub 2010 Oct 6.  Avoiding skin burns with transcranial direct current stimulation: preliminary considerations. Loo CK, DM, Alonzo A, Gandevia S, PB, Sachdev P. School of Psychiatry, University of New South Wales, Sydney, Australia. http://www.ncbi.nlm.nih.gov/pubmed/20923600  J ECT. 2011 Jan 4. [Epub ahead of print] Hypomania Induction in a Patient With Bipolar II Disorder by Transcranial Direct Current Stimulation (tDCS). Gálvez V, Alonzo A, D, PB, Sachdev P, Loo CK. http://www.ncbi.nlm.nih.gov/pubmed/21206371 We report the case of a 33-year-old female with bipolar II disorder, on mood stabilizer medication, who had previously participated in a clinical trial of tDCS given with a bifrontal electrode montage for the treatment of major depression without incident, but became hypomanic when she received a later course of tDCS given with a frontoextracephalic configuration. When the reference cathodal electrode in tDCS is moved from the cranium to an extracephalic position, larger areas of both cerebral hemispheres are stimulated, with potential implications for both efficacy and safety. In particular, it raises the question of whether frontoextracephalic tDCS requires additional precautions when administered to bipolar patients compared to bifrontal tDCS  Brain Stimul. 2011 Jan;4(1):38-42. Epub 2010 Jun 17. Reducing procedural pain and discomfort associated with transcranial direct current stimulation. McFadden JL, Borckardt JJ, MS, Beam W. Brain Stimulation Laboratory, Medical University of South Carolina, ton, South Carolina, USA. http://www.ncbi.nlm.nih.gov/pubmed/21255753 Though tDCS as presently applied causes no apparent harm to brain structure or function, a number of uncomfortable sensations can occur beneath the electrodes during stimulation, including tingling, pain, itching, and burning sensations. Therefore, we investigated the effect of topically applied Eutectic mixture of local anesthetics (EMLA) on tDCS-related discomfort. On average, the mean sensation ratings for EMLA-associated tDCS stimulation were significantly lower than placebo-associated stimulation for every cutaneous sensation evaluated. Cathodal stimulation was associated with higher ratings of " sharpness " and intolerability than anodal stimulation.  J ECT. 2010 Oct 5. [Epub ahead of print] Cognitive, Mood, and Electroencephalographic Effects of Noninvasive Cortical Stimulation With Weak Electrical Currents. Tadini L, El-Nazer R, Brunoni AR, J, Carvas M, Boggio P, Priori A, Pascual-Leone A, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/20938352 Here, we show no neurophysiological or behavioral signs that transcranial DC stimulation or AC stimulation with weak currents induce deleterious changes when comparing active and sham groups. This study provides therefore additional information for researchers and ethics committees, adding important results to the safety pool of studies assessing the effects of cortical stimulation using weak electrical currents. Further studies in patients with neuropsychiatric disorders are warranted.  Neuroimage. 2010 Oct 1;52(4):1268-78. Epub 2010 May 7. Transcranial direct current stimulation in patients with skull defects and skull plates: high-resolution computational FEM study of factors altering cortical current flow. Datta A, Bikson M, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/20435146 As the conductivity of large skull defects/plates was increased (chronic to acute to titanium), current was shunted away from directly underlying cortex and concentrated in cortex underlying the defect perimeter. The predictions of this study are the first step to assess safety of transcranial electrical therapy in subjects with skull injuries and skull plates.  BMC Neurosci. 2010 Mar 16;11:38. Effect of tDCS with an extracephalic reference electrode on cardio-respiratory and autonomic functions. Vandermeeren Y, Jamart J, Ossemann M. http://www.ncbi.nlm.nih.gov/pubmed/20233439 Applying tDCS with an extracephalic reference electrode in healthy volunteers did not significantly modulate the activity of the brainstem autonomic centres. Therefore, using an extracephalic reference electrode for tDCS appears safe in healthy volunteers, at least under similar experimental conditions.  J ECT. 2010 Mar;26(1):68-9. Induction of hypomanic episode with transcranial direct current stimulation. Arul-Anandam AP, Loo C, P. http://www.ncbi.nlm.nih.gov/pubmed/19483641 We report on the case of a 57-year-old man who experienced an episode of hypomania while participating in a clinical trial of transcranial direct current stimulation for the treatment of major depressive disorder. Although hypomania and mania have been reported after transcranial magnetic stimulation to the dorsolateral prefrontal cortex in the past, to our knowledge, this is the first report of mania after transcranial direct current stimulation to the dorsolateral prefrontal cortex.  Brain Stimul. 2010 Jan;3(1):58-9. Epub 2009 May 20. Anodal skin lesions after treatment with transcranial direct current stimulation. E, Wilfurth S, Landgrebe M, Eichhammer P, Hajak G, Langguth B. http://www.ncbi.nlm.nih.gov/pubmed/20633432  J ECT. 2009 Dec;25(4):256-60. Transcranial direct current stimulation priming of therapeutic repetitive transcranial magnetic stimulation: a pilot study. Loo C, D, Pigot M, Arul-Anandam P, P, Sachdev P. http://www.ncbi.nlm.nih.gov/pubmed/19440158 preconditioning with tDCS may greatly increase the pain experienced with subsequent rTMS.  F1000 Med Rep. 2009 Jul 27;1. pii: 58. Transcranial direct current stimulation - what is the evidence for its efficacy and safety? Arul-Anandam AP, Loo C, Sachdev P. http://www.ncbi.nlm.nih.gov/pubmed/20948722 A number of recent studies suggest that tDCS is safe and may be efficacious in the treatment of a variety of psychiatric and neurological disorders, including major depressive disorder, chronic neuropathic pain, and stroke. More evidence is necessary, however, before it can be recommended for general clinical application.  Clin Neurophysiol. 2009 Jun;120(6):1033-4. Epub 2009 Apr 24. Establishing safety limits for transcranial direct current stimulation. Bikson M, Datta A, Elwassif M. Comment on:    Clin Neurophysiol. 2009 Jun;120(6):1161-7. http://www.ncbi.nlm.nih.gov/pubmed/19394269  Clin Neurophysiol. 2009 Jun;120(6):1161-7. Epub 2009 Apr 28. Safety limits of cathodal transcranial direct current stimulation in rats. Liebetanz D, Koch R, Mayenfels S, König F, us W, Nitsche MA. http://www.ncbi.nlm.nih.gov/pubmed/19403329 N=58 rats. At tDCS intensity levels two orders of magnitude above those given to humans, the rats had no lesions. Although these results cannot be directly transferred to humans, they encourage the development of intensified tDCS protocols.  Clin Neurophysiol. 2009 Jan;120(1):80-4. Epub 2008 Nov 21. Bilateral frontal transcranial direct current stimulation: Failure to replicate classic findings in healthy subjects. Koenigs M, Ukueberuwa D, Campion P, Grafman J, Wassermann E. http://www.ncbi.nlm.nih.gov/pubmed/19027357 N=21; These results demonstrate the safety of bilateral anterior frontal TDCS with an extra-cephalic reference, but raise questions about its effectiveness as a modulator of mood and emotional cognition, at least in healthy subjects.  J Cogn Neurosci. 2008 Sep;20(9):1687-97. Cerebellar transcranial direct current stimulation impairs the practice-dependent proficiency increase in working memory. Ferrucci R, Marceglia S, Vergari M, Cogiamanian F, Mrakic-Sposta S, Mameli F, Zago S, Barbieri S, Priori A. http://www.ncbi.nlm.nih.gov/pubmed/18345990  Conf Proc IEEE Eng Med Biol Soc. 2009;2009:670-3. Bio-heat transfer model of transcranial DC stimulation: comparison of conventional pad versus ring electrode. Datta A, Elwassif M, Bikson M. http://www.ncbi.nlm.nih.gov/pubmed/19964238 The tissue temperature increases of tDCS using conventional rectangular-pad (7 x 5 cm(2)) and HD-tDCS using the ring (4 x 1) electrode configurations were compared using a bio-heat model. Our results indicate that clinical tDCS does not increase tissue temperature and 4 x 1 ring configurations leads to a negligible increase in scalp temperature.  Brain Res Bull. 2007 May 30;72(4-6):208-14. Epub 2007 Jan 24. Safety aspects of transcranial direct current stimulation concerning healthy subjects and patients. Poreisz C, Boros K, Antal A, us W. http://www.ncbi.nlm.nih.gov/pubmed/17452283 The aim of this paper is to summarize the partially adverse effects of 567 tDCS sessions over motor and non-motor cortical areas (occipital, temporal, parietal) from the last 2 years, on work performed in our laboratories. One-hundred and two of our subjects who participated in our tDCS studies completed a questionnaire. Participants were healthy subjects (75.5%), migraine patients (8.8%), post-stroke patients (5.9%) and tinnitus patients (9.8%). During tDCS a mild tingling sensation was the most common reported adverse effect (70.6%), moderate fatigue was felt by 35.3% of the subjects, whereas a light itching sensation under the stimulation electrodes occurred in 30.4% of cases. After tDCS headache (11.8%), nausea (2.9%) and insomnia (0.98%) were reported, but fairly infrequently. In addition, the incidence of the itching sensation (p=0.02) and the intensity of tingling sensation (p=0.02) were significantly higher during tDCS in the group of the healthy subjects, in comparison to patients; whereas the occurrence of headache was significantly higher in the patient group (p=0.03) after the stimulation. Our results suggest that tDCS applied to motor and non-motor areas according to the present tDCS safety guidelines, is associated with relatively minor adverse effects in healthy humans and patients with varying neurological disorders.  Clin Neurophysiol. 2007 May;118(5):1166-70. Epub 2007 Feb 27. Perception of comfort during transcranial DC stimulation: effect of NaCl solution concentration applied to sponge electrodes. Dundas JE, Thickbroom GW, Mastaglia FL. http://www.ncbi.nlm.nih.gov/pubmed/17329167 The application of NaCl solutions between 15 and 140 mM to sponge electrodes is more likely to be perceived as comfortable during tDCS. SIGNIFICANCE: The reporting of solution concentration and ratings of perception would be useful adjuncts to tDCS studies.  Neurology. 2005 Mar 8;64(5):872-5. Safety and cognitive effect of frontal DC brain polarization in healthy individuals. Iyer MB, Mattu U, Grafman J, Lomarev M, Sato S, Wassermann EM. http://www.ncbi.nlm.nih.gov/pubmed/15753425 There were no significant effects on performance with 1 mA DC. At 2 mA, verbal fluency improved significantly with anodal and decreased mildly with cathodal DC. There were no clinically significant effects on the other measures. CONCLUSIONS: Limited exposure to direct current polarization of the prefrontal cortex is safe and can enhance verbal fluency selectively in healthy subjects. As such, it deserves consideration as a procedure to improve frontal lobe function in patients.  Clin Neurophysiol. 2003 Nov;114(11):2220-2; author reply 2222-3. Safety criteria for transcranial direct current stimulation (tDCS) in humans. Nitsche MA, Liebetanz D, Lang N, Antal A, Tergau F, us W. http://www.ncbi.nlm.nih.gov/pubmed/14580622          Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2011 Report Share Posted August 20, 2011 Doug, I so appreciate your missivesand would also appreciate if you would compare the tDCS with Dave Siever's CES.Also, is the tDCS group part of ?Thanks,Jill Swartz, , BC On Thu, Aug 11, 2011 at 6:56 AM, gary levine <garydrewlevine@...> wrote:  Doug, Could you compare tDCS efficacy with cranial electric stim devices such as Alpha-Stim or the CES that is built into Dave Siever's auditory-visual entrainment devices?  Sincerely, Levine On Thu, Aug 11, 2011 at 9:48 AM, Dailey <ddailey@...> wrote:  Hello Bruce,  Like usual, you have raised some interesting questions that warrant discussion. Please remember - my opinions are just theories - they are never true or false, but simply either useful or not useful.  Being the well-qualified and busy pri Bactitioner that you are, you are aware that any intersection between ourselves and a client can be potentially hazardous. Even family counseling can have adverse repercussions that effect the health and well-being of several generations. We all take risks, patient and practitioner, in an informed way, if we are convinced, in each particular case, that the benefit outweighs the risk.  I don't know about you, but I have never had a client that was in someone else's scientific study, where the experimental groups were chosen extremely strictly and usually had no comorbidities. Unlike the carefully selected subjects in the restrictive study, our real-life patients have messy complicated lives and are under the influence of multiple confounding factors.  This is why medicine is an art - not a science. Try as we might, we may never fit each client into some statistical distribution of properties required for a controlled study. When we do - then it often becomes " For whom the bell-shaped curve tolls. " I can't even begin to tell you how many times people have been told that there is nothing wrong with them because each of their lab values fits into the plus and minus 2 standard deviations of the distribution seen in 'healthy' people. There are at least three flaws with this time saving (money making) approach. 1) The 'healthy' controls who are sampled are well on their own way to illness and are not followed; 2) just because your level of thyroid hormone (for example) has also been seen in the abstract group of " normals " , it does not follow that it is normal for you; 3) Our clients also differ from any of those in the abstract studies because they are usually receiving several types of other interventions which may include counseling, neuromodulation, medication, herbs and supplements, and toxic exposures at home or at work (not to mention toxic root canals, family history of schizophrenia and bipolar disorder, fibromyalgia, cerebrovascular disease, incipient diabetes and cancer and so forth).  Every client is a mystery with his or her own hidden weaknesses. That is why, I would think, that our prime directive is " First of all - Do no harm. " As you pointed out, since we can't foresee the future, anything we do will have repercussions that continue long after we are gone.  As you also pointed out, even meditation instruction can cause some clients to develop relaxation induced anxiety. Even worse, as Lee Sanella, MD, in his book " Kundalini - Psychosis or Transference? " pointed out, there is a long well-known appreciation in the literature that " meditation illness " is a common and debilitating disorder, often refractory to any treatment.  So let's get back to tDCS. At the very bottom I will give you citations and abstracts for 22 studies on the safety of tDCS. These are more than you are likely to find regarding the safety of neurofeedback. And these are almost all studies done in major universities and published in a wide variety of peer reviewed journals.  Let's look at the studies on tDCS and depression. I have included 22 citations and abstracts on this as well. Among other things, these studies have shown that treatment resistant, suicidal, hospitalized depressive who were given only 5 days of tDCS treatment were shown to do better at 6 week follow-up than similar depressives who responded well to drugs.  There are several 'take home' lessons for me in these studies. One is that all the tDCS protocols for depression used the positive anode at F3 - the dorsolateral prefrontal cortex - exactly where neurofeedback usually targets its influence for depression, an area whose involvement is documented by fMRI and QEEG. The second lesson is that tDCS treats these regions in a way known to mimic normal physiological mechanisms - increasing or decreasing the excitability of neuronal pools by altering the charge difference between the inside and the outside of the neurons. The third lesson is that with tDCS there were no drug side effects and that 5 days of focused tDCS treatment exceeded the results of 6 weeks of daily drug use. In addition, the tDCS brought relief much more quickly than drugs.  Bruce, nobody knows how or if tDCS, neurofeedback, and even, as you mentioned, coffee and meditation, might adversely affect current or future generations. There are many hundreds of studies documenting devastation due to pesticides, genetically modified foods, fragrances, pollution, lack of exercise, neglect, unpredictable stress, and impoverishment. Yet many people will not budge on their lifestyles. Once again it ends up being a risk-benefit analysis, such as we do all the time, and for which, as professionals, we must be constantly educating ourselves.  I will very quickly summarize the tDCS safety information, although I suggest you consult the sources. tDCS can cause a burn to the skin. This rarely occurs because clients will comment if they feel discomfort; but it is a risk for those will lowered skin sensitivity. There were two cases where bipolar depression was lifted but hypomania ensued. That has not occurred since a new electrode montage has become standard. Otherwise, the only 'side effects' are tingling and itching and occasional momentary headache, all of which can be relieved by reducing the current. The investigators could not reduce the current in the studies or the math would have been thrown off - so some subjects had to endure 20 minutes of fire ants on their scalps. In the clinic you set the current for comfort, even if it means you extend your treatment time by a few minutes.  I hope this has helped you answer your question yourself. I believe that I know from our conversations how carefully and strictly you want to use your tools. Otherwise how could we judge our results.  I would be happy to contact you back channel if you are interested in tDCS. Its documented ability to improve cortical glucose tolerance, neuroplasticity, neuroprotection, and learning make it an exceptionally fine tool to use prior to neurofeedback, or simultaneously with HEG and HRV.  I invite you, and any other readers, to join the absolutely new group on tDCStim. At present there are only a handful of members; but it is the only English language tDCS group, and the only active tDCS group anywhere. Being a member will ensure that you will get updates on new studies and that you can talk about tDCS with other experts who have an interest in neurofeedback as well.  Group home page: tDCStim Group email address: tDCStim  Best wishes,  Dailey   ---------------------------- Studies on Depression  J Affect Disord. 2011 Jun 2. Fronto-extracephalic transcranial direct current stimulation as a treatment for major depression: An open-label pilot study. DM, Alonzo A, PB, Sachdev P, Gálvez V, Loo CK. http://www.ncbi.nlm.nih.gov/pubmed/21641047 BACKGROUND: Several recent trials have reported transcranial direct current stimulation (tDCS) to be effective in treating depression, though the relative benefits of different electrode montages remain unexplored. Whereas all recent studies have used a bifrontal (BF) electrode montage, studies published in the 1960s and 1970s placed one electrode in an extracephalic position, with some positive reports of efficacy. This study investigated the efficacy and safety of tDCS given with a fronto-extracephalic (F-EX) montage. METHODS: 2mA tDCS was administered for 20min every weekday over four weeks in 11 participants with a Major Depressive Episode who had previously shown inadequate response to, or relapsed following, a course of BF tDCS. For F-EX tDCS the anode was placed on the left dorsolateral prefrontal cortex and the cathode on the right upper arm. Depression severity and neuropsychological function were assessed before and after the treatment course. Antidepressant response was compared across an equivalent treatment period for both montages. RESULTS: F-EX tDCS was shown to be safe and well tolerated. Depression ratings improved after acute treatment on the Montgomery Åsberg Depression Rating Scale (p<0.001). Participants showed greater initial treatment response with F-EX tDCS than with BF tDCS (p<0.001). LIMITATIONS: This was an open label pilot study. The two comparison treatments were applied consecutively. CONCLUSION: F-EX tDCS appears to be safe and to have antidepressant effects, and may lead to more rapid improvement than tDCS given with a BF montage.  Eur Psychiatry. 2011 May 27. Transcranial direct current stimulation for the outpatient treatment of poor-responder depressed patients. Dell'osso B, Zanoni S, Ferrucci R, Vergari M, Castellano F, D'Urso N, Dobrea C, Benatti B, Arici C, Priori A, Altamura AC. http://www.ncbi.nlm.nih.gov/pubmed/21621982 Transcranial direct current stimulation (tDCS) is a selective, painless, brain stimulation technique that allows the electric stimulation of specific cortical regions. TDCS has been recently used as investigational intervention for major depression and treatment resistant depression (TRD) with encouraging results. The present study was aimed to investigate the efficacy and tolerability of tDCS in major depressives with poor response to pharmacological treatment. Twenty-three depressed patients, with a diagnosis of major depressive disorder or bipolar disorder, were treated with augmentative tDCS for 5 days, two sessions per day in a blind-rater trial. The course of depressive symptoms was analyzed using repeated measures ANOVA for HAM-D and MADRS total scores. A qualitative analysis on the basis of the HAM-D response was performed as well. Both analyses were conducted at three time-points: T0 (baseline), T1 (endpoint tDCS) and T2 (end of the first week of follow-up). All patients completed the trial without relevant side-effects. A significant reduction of HAM-D and MADRS total scores was observed during the study (P<0.0001). Treatment response (endpoint HAM-D reduction ≥50%) was obtained by four patients (17.4%) at T1 and by seven patients (30.4%) at T2 and remission (endpoint HAM-D<8) by three patients (13.0%) at T1 and by four subjects (17.4%) at T2. Present findings support the efficacy and good tolerability of tDCS in the acute treatment of patients with TRD with clinical benefit being progressive and extended to the first week of follow-up. Further sham-controlled trials with longer follow-up are needed to confirm present results.  Neurocase. 2011 Jan 6:1-5. [Epub ahead of print] Mood and cognitive effects of transcranial direct current stimulation in post-stroke depression. Bueno VF, Brunoni AR, Boggio PS, Bensenor IM, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/21213180 Here, we report a patient with significant mood and cognitive impairment who showed marked amelioration of these symptoms following anodal stimulation (2 mA per 30 minutes per 10 days) over the left dorsolateral prefrontal cortex.  Prog Neuropsychopharmacol Biol Psychiatry. 2011 Jan 15;35(1):96-101. Epub 2010 Sep 18. Transcranial direct current stimulation (tDCS) in unipolar vs. bipolar depressive disorder. Brunoni AR, http://www.ncbi.nlm.nih.gov/pubmed/20854868 We applied tDCS over the dorsolateral prefrontal cortex (anodal electrode on the left and cathodal on the right) using a 2 mA-current for 20 min, twice-daily, for 5 consecutive days. Depression was measured at baseline, after 5 tDCS sessions, one week later, and one month after treatment onset. We used the scales of Beck (BDI) and Hamilton-21 items (HDRS). All patients tolerated treatment well without adverse effects. After the fifth tDCS session, depressive symptoms in both study groups diminished, and the beneficial effect persisted at one week and one month. In conclusion, our preliminary study suggests that tDCS is a promising treatment for patients with MDD and BDD.  Neurocase. 2011 Jan 6:1-5. [Epub ahead of print] Mood and cognitive effects of transcranial direct current stimulation in post-stroke depression. Bueno VF, Brunoni AR, Boggio PS, Bensenor IM, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/21213180 " marked amelioration of these symptoms following anodal stimulation (2 mA per 30 minutes per 10 days) over the left dorsolateral prefrontal cortex. "  Int J Neuropsychopharmacol. 2010 Feb;13(1):61-9. Epub 2009 Aug 12. A double-blind, sham-controlled trial of transcranial direct current stimulation for the treatment of depression. Loo CK, Sachdev P, D, Pigot M, Alonzo A, Malhi GS, Lagopoulos J,  P. http://www.ncbi.nlm.nih.gov/pubmed/19671217 N=40; This double-blind, randomized study tested tDCS at the same stimulation parameters as a previous positive study (1 mA current strength, five treatment sessions, active or sham, given on alternate days) in 40 depressed participants. Anodal stimulation was centered over the left dorsolateral prefrontal cortex, with the cathode placed on the lateral aspect of the contralateral orbit. tDCS was continued up to a total of ten active sessions per participant. Overall depression scores improved significantly over ten tDCS treatments... tDCS was found to be safe, with no adverse effects on neuropsychological function, and only minor side-effects.  Arq Neuropsiquiatr. 2010 Jun;68(3):433-51. Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting. Brunoni AR, Teng CT, Correa C, Imamura M, Brasil-Neto JP, Boechat R, M, Caramelli P, Cohen R, Del Porto JA, Boggio PS, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/20602051  J Affect Disord. 2009 Nov;118(1-3):215-9. Epub 2009 Mar 16. Transcranial direct current stimulation in severe, drug-resistant major depression. Ferrucci R, Bortolomasi M, Vergari M, Tadini L, Salvoro B, Giacopuzzi M, Barbieri S, Priori A. http://www.ncbi.nlm.nih.gov/pubmed/19286265 N=14 hospitalized MDD with high suicide risk and referred for ECT. . tDCS was delivered over the dorsolateral prefrontal cortex (DLPC) (2 mA, 20 min, anode left, cathode right) twice a day. After five days of treatment although cognitive performances remained unchanged, the BDI and HDRS scores improved more than 30% (BDI p=0.001; HDRS p=0.017). The mood improvement persisted and even increased at four (T2) weeks after treatment ended. We conclude that frontal tDCS is a simple, promising technique that can be considered in clinical practice as adjuvant treatment for hospitalized patients with severe, drug-resistant major depression.  J Affect Disord. 2009 Oct;117(3):137-45. Epub 2009 Feb 7. Transcranial direct current stimulation: a new tool for the treatment of depression? Arul-Anandam AP, Loo C. http://www.ncbi.nlm.nih.gov/pubmed/19201483 We briefly review tDCS clinical trials for MDD, and then consider its mechanisms of action, identifying potential avenues for future research.  Exp Neurol. 2009 Sep;219(1):14-9. Epub 2009 Apr 5. Treatment of depression with transcranial direct current stimulation (tDCS): a review. Nitsche MA, Boggio PS, Fregni F, Pascual-Leone A. http://www.ncbi.nlm.nih.gov/pubmed/19348793 Major Depression Disorder (MDD) is usually accompanied by alterations of cortical activity and excitability, especially in prefrontal areas. These are reflections of a dysfunction in a distributed cortico-subcortical, bihemispheric network. Early studies from the 1960s suggested some efficacy of DC stimulation to reduce symptoms in depression, but mixed results and development of psychotropic drugs resulted in an early abandonment of this technique. In the last years tDCS protocols have been optimized. Application of the newly developed stimulation protocols in patients with major depression has shown promise in few pilot studies.  Curr Opin Psychiatry. 2009 May;22(3):306-11. Transcranial direct current stimulation as a therapeutic tool for the treatment of major depression: insights from past and recent clinical studies. DN, Boggio P, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/19339889 tDCS is associated with significant clinical gains. ... it appears that current methods of tDCS might not be fully optimized and, in fact, (1) individualized parameters of stimulation, (2) longer stimulation sessions, and (3) methods to focalize tDCS might be useful strategies to provide greater clinical benefits.  Rev Bras Psiquiatr. 2009 May;31 Suppl 1:S34-8. Transcranial direct current stimulation: a promising alternative for the treatment of major depression? Berlim MT, Dias Neto V, Turecki G. http://www.ncbi.nlm.nih.gov/pubmed/19565150 Current protocols for the treatment of major depression with transcranial direct current stimulation usually involve the application of two sponge-electrodes in the scalp. In general, the positive electrode is applied in the region above the left dorsolateral prefrontal cortex (i.e., F3 region of the 10/20 International System for EEG) and the negative electrode is applied in the region above the right supra-orbital area. A direct electrical current of 1-2 mA is then applied between the electrodes for about 20 minutes, with sessions being daily performed for one to two weeks. Recent studies show that transcranial direct current stimulation is an important neuromodulatory method that may be useful for the treatment of depressed patients.  Ther Clin Risk Manag. 2009;5:897-910. Epub 2009 Nov 18. Pharmacological and combined interventions for the acute depressive episode: focus on efficacy and tolerability. Brunoni AR, Fraguas R, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/19956554 A search was undertaken in MEDLINE, Web of Science, Cochrane, and Scielo databases. We included: 21 meta-analyses of antidepressant trials, 15 neurostimulation clinical trials and 8 studies of pharmacoeconomics. These therapies might be interesting augmentation strategies, considering their benign profile of side effects, if proper safety parameters are adopted.  World J Biol Psychiatry. 2009;10(4 Pt 2):632-5. Transcranial direct current stimulation in a patient with therapy-resistant major depression. Palm U, Keeser D, Schiller C, Fintescu Z, Reisinger E, Baghai TC, Mulert C, Padberg F. http://www.ncbi.nlm.nih.gov/pubmed/19995213 N=1; female patient suffering from recurrent major depressive episodes who underwent anodal tDCS of the left dorsolateral PFC over 4 weeks as an add-on treatment. Only a modest improvement of depressive symptoms was observed after tDCS,... However, there was an increase from 52 to 90% in the Regensburg Verbal Fluency Test. Low resolution brain electromagnetic tomography (LORETA) showed a left unilateral focal effect (25-40% reduced power) in the delta, theta and alpha frequency bands. The same effect appeared in the surface analysis of the EEG. The absolute, as well as the relative power decreased significantly in the delta, theta and alpha bands after a comparison of the spectral analysis.  Curr Psychiatry Rep. 2008 Dec;10(6):465-73. Novel targets for antidepressant therapies. Holtzheimer PE, Nemeroff CB. http://www.ncbi.nlm.nih.gov/pubmed/18980729  Curr Treat Options Neurol. 2008 Sep;10(5):377-85. Transcranial direct current stimulation for major depression: a general system for quantifying transcranial electrotherapy dosage. Bikson M, Bulow P, Stiller JW, Datta A, Battaglia F, Karnup SV, Postolache TT. http://www.ncbi.nlm.nih.gov/pubmed/18782510 If tDCS can be established as an effective treatment for depression, it would represent a particularly attractive electrotherapy option, as it is a relatively benign and affordable treatment modality. An accurate system for describing reproducible treatment parameters is essential so that further studies can yield evidence-based guidelines for the clinical use of transcranial current stimulation  Int J Neuropsychopharmacol. 2008 Mar;11(2):249-54. Epub 2007 Jun 11. A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. Boggio PS, Rigonatti SP, Ribeiro RB, Myczkowski ML, Nitsche MA, Pascual-Leone A, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/17559710 N=40; 10 sessions over a 2 week period of anodal tDCS to the left dorsolateral prefrontal cortex lead to " significantly larger reductions in depression scores after DLPFC tDCS. ...The beneficial effects of tDCS in the DLPFC group persisted for 1 month after the end of treatment  Eur Psychiatry. 2008 Jan;23(1):74-6. Epub 2007 Nov 19. Transcranial direct stimulation and fluoxetine for the treatment of depression. Rigonatti SP, Boggio PS, Myczkowski ML, Otta E, Fiquer JT, Ribeiro RB, Nitsche MA, Pascual-Leone A, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/18023968 N=42; Patients were moderately depressed, off medication for two month. We compared the findings of a parallel-group, randomized, double-blind clinical trial investigating the effects of active vs. sham tDCS with an open-label trial in which patients with similar clinical characteristics received fluoxetine, a frequently prescribed serotonin reuptake inhibitor.Protocol: 2 mA of intensity for 20 min for 10 days (anodal electrode on the left dorsolateral prefrontal cortex and cathode electrode on the contralateral supraorbital area). All patients were assessed at baseline and after 2, 4, and 6 weeks after the onset of treatment (tDCS or fluoxetine). Results: the antidepressant effects of non-invasive brain stimulation with tDCS are similar to those of a 6-week course of fluoxetine at a relatively small dose of 20 mg/day. However, the antidepressant benefit of tDCS appears to become significant faster than the benefit of fluoxetine.  J Affect Disord. 2007 Aug;101(1-3):91-8. Epub 2006 Dec 12. Go-no-go task performance improvement after anodal transcranial DC stimulation of the left dorsolateral prefrontal cortex in major depression. Boggio PS, Bermpohl F, Vergara AO, Muniz AL, Nahas FH, Leme PB, Rigonatti SP, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/17166593 ....anodal stimulation of the left DLPFC was the only condition that induced a significant improvement in task performance as shown by the increase in the number of correct responses. In addition, this effect was specific for figures with positive emotional content. This performance enhancement was not correlated with mood changes after 10 days of tDCS treatment.  Clin EEG Neurosci. 2007 Apr;38(2):105-15. Transcranial and deep brain stimulation approaches as treatment for depression. Rau A, Grossheinrich N, Palm U, Pogarell O, Padberg F. http://www.ncbi.nlm.nih.gov/pubmed/17515176 Several brain stimulation approaches are currently being investigated as novel therapeutic interventions beside electroconvulsive therapy (ECT), a prototypic method in this field with proven effectiveness. These neurostimulation methods include repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST), vagus nerve stimulation (VNS), deep brain stimulation (DBS) and transcranial direct current stimulation (tDCS). It is via different neuroanatomically defined " windows " that the various approaches access the neuronal networks showing an altered function in depression. Also, the methods vary regarding their degree of invasiveness. One or the other method may finally achieve antidepressant effectiveness with minimized side effects and constitute a new effective treatment for major depression.  Bipolar Disord. 2006 Apr;8(2):203-4. Treatment of major depression with transcranial direct current stimulation. Fregni F, Boggio PS, Nitsche MA, Marcolin MA, Rigonatti SP, Pascual-Leone A. http://www.ncbi.nlm.nih.gov/pubmed/16542193 N=10; tDCS was applied through a saline-soaked pair of surface sponge electrodes (35 cm2). The anode electrode was placed over F3 (10–20 International EEG System) of each subject. The cathode was placed over the contralateral supraorbital area. A constant current of 1 mA strength was applied for 20 min/day (administered for five alternated days). All patients tolerated tDCS without complications. At the end of treatment, there were four treatment responders in the active group versus no responders in the sham group. This treatment is inexpensive, easy to administer, non-invasive and painless.  Depress Anxiety. 2006;23(8):482-4. Cognitive effects of repeated sessions of transcranial direct current stimulation in patients with depression. Fregni F, Boggio PS, Nitsche MA, Rigonatti SP, Pascual-Leone A. http://www.ncbi.nlm.nih.gov/pubmed/16845648 The clinical utility of transcranial direct current stimulation (tDCS) has been discussed and explored for almost 40 years....recent investigations using different electrodes size and position, and different stimulation parameters have demonstrated that this technique is a robust method to modulate brain excitability probably on the basis of shifts in neuronal membrane excitability in patients with major depression. In this trial, we investigated the cognitive effects of 5 days of anodal stimulation of the left DLPFC in 18 patients with major depression. A neuropsychological battery was assessed immediately before the first day of treatment and immediately after the last treatment day (fifth session). The anode electrode was placed over F3 (10–20 International EEG System) of each subject. The cathode (reference electrode) was placed over the contralateral supraorbital area. A constant current of 1-mA strength was applied for 20 minutes per day (administered for 5 alternate days) during the morning (8:00 to 10:00 A.M.). Repeated sessions of active tDCS do not result in cognitive impairment compared to placebo tDCS in patients with major depression; on the contrary, they appear able to improve one aspect of cognitive function—working memory. This cognitive enhancement was not observed after sham tDCS and was not correlated with mood effects. This is in line with a previous study that showed an enhancement of working memory after a single session of tDCS of the left DLPFC in healthy subjects   --------------------------- Studies on Safety  Biol Psychiatry. 2011 Apr 15;69(8):e23-4. Epub 2011 Feb 18. Efficacy and safety of transcranial direct current stimulation in major depression. Dell'osso B, Priori A, Altamura AC. http://www.ncbi.nlm.nih.gov/pubmed/21310394  Int J Neuropsychopharmacol. 2011 Feb 15:1-13. [Epub ahead of print] A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. Brunoni AR, Amadera J, Berbel B, Volz MS, Rizzerio BG, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/21320389  J ECT. 2011 Jan 4. [Epub ahead of print] Hypomania Induction in a Patient With Bipolar II Disorder by Transcranial Direct Current Stimulation (tDCS). Gálvez V, Alonzo A, D, PB, Sachdev P, Loo CK. http://www.ncbi.nlm.nih.gov/pubmed/21206371 participated in a clinical trial of tDCS given with a bifrontal electrode montage for the treatment of major depression without incident, but became hypomanic when she received a later course of tDCS given with a frontoextracephalic configuration.  Int J Neuropsychopharmacol. 2011 Apr;14(3):425-6. Epub 2010 Oct 6.  Avoiding skin burns with transcranial direct current stimulation: preliminary considerations. Loo CK, DM, Alonzo A, Gandevia S, PB, Sachdev P. School of Psychiatry, University of New South Wales, Sydney, Australia. http://www.ncbi.nlm.nih.gov/pubmed/20923600  J ECT. 2011 Jan 4. [Epub ahead of print] Hypomania Induction in a Patient With Bipolar II Disorder by Transcranial Direct Current Stimulation (tDCS). Gálvez V, Alonzo A, D, PB, Sachdev P, Loo CK. http://www.ncbi.nlm.nih.gov/pubmed/21206371 We report the case of a 33-year-old female with bipolar II disorder, on mood stabilizer medication, who had previously participated in a clinical trial of tDCS given with a bifrontal electrode montage for the treatment of major depression without incident, but became hypomanic when she received a later course of tDCS given with a frontoextracephalic configuration. When the reference cathodal electrode in tDCS is moved from the cranium to an extracephalic position, larger areas of both cerebral hemispheres are stimulated, with potential implications for both efficacy and safety. In particular, it raises the question of whether frontoextracephalic tDCS requires additional precautions when administered to bipolar patients compared to bifrontal tDCS  Brain Stimul. 2011 Jan;4(1):38-42. Epub 2010 Jun 17. Reducing procedural pain and discomfort associated with transcranial direct current stimulation. McFadden JL, Borckardt JJ, MS, Beam W. Brain Stimulation Laboratory, Medical University of South Carolina, ton, South Carolina, USA. http://www.ncbi.nlm.nih.gov/pubmed/21255753 Though tDCS as presently applied causes no apparent harm to brain structure or function, a number of uncomfortable sensations can occur beneath the electrodes during stimulation, including tingling, pain, itching, and burning sensations. Therefore, we investigated the effect of topically applied Eutectic mixture of local anesthetics (EMLA) on tDCS-related discomfort. On average, the mean sensation ratings for EMLA-associated tDCS stimulation were significantly lower than placebo-associated stimulation for every cutaneous sensation evaluated. Cathodal stimulation was associated with higher ratings of " sharpness " and intolerability than anodal stimulation.  J ECT. 2010 Oct 5. [Epub ahead of print] Cognitive, Mood, and Electroencephalographic Effects of Noninvasive Cortical Stimulation With Weak Electrical Currents. Tadini L, El-Nazer R, Brunoni AR, J, Carvas M, Boggio P, Priori A, Pascual-Leone A, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/20938352 Here, we show no neurophysiological or behavioral signs that transcranial DC stimulation or AC stimulation with weak currents induce deleterious changes when comparing active and sham groups. This study provides therefore additional information for researchers and ethics committees, adding important results to the safety pool of studies assessing the effects of cortical stimulation using weak electrical currents. Further studies in patients with neuropsychiatric disorders are warranted.  Neuroimage. 2010 Oct 1;52(4):1268-78. Epub 2010 May 7. Transcranial direct current stimulation in patients with skull defects and skull plates: high-resolution computational FEM study of factors altering cortical current flow. Datta A, Bikson M, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/20435146 As the conductivity of large skull defects/plates was increased (chronic to acute to titanium), current was shunted away from directly underlying cortex and concentrated in cortex underlying the defect perimeter. The predictions of this study are the first step to assess safety of transcranial electrical therapy in subjects with skull injuries and skull plates.  BMC Neurosci. 2010 Mar 16;11:38. Effect of tDCS with an extracephalic reference electrode on cardio-respiratory and autonomic functions. Vandermeeren Y, Jamart J, Ossemann M. http://www.ncbi.nlm.nih.gov/pubmed/20233439 Applying tDCS with an extracephalic reference electrode in healthy volunteers did not significantly modulate the activity of the brainstem autonomic centres. Therefore, using an extracephalic reference electrode for tDCS appears safe in healthy volunteers, at least under similar experimental conditions.  J ECT. 2010 Mar;26(1):68-9. Induction of hypomanic episode with transcranial direct current stimulation. Arul-Anandam AP, Loo C, P. http://www.ncbi.nlm.nih.gov/pubmed/19483641 We report on the case of a 57-year-old man who experienced an episode of hypomania while participating in a clinical trial of transcranial direct current stimulation for the treatment of major depressive disorder. Although hypomania and mania have been reported after transcranial magnetic stimulation to the dorsolateral prefrontal cortex in the past, to our knowledge, this is the first report of mania after transcranial direct current stimulation to the dorsolateral prefrontal cortex.  Brain Stimul. 2010 Jan;3(1):58-9. Epub 2009 May 20. Anodal skin lesions after treatment with transcranial direct current stimulation. E, Wilfurth S, Landgrebe M, Eichhammer P, Hajak G, Langguth B. http://www.ncbi.nlm.nih.gov/pubmed/20633432  J ECT. 2009 Dec;25(4):256-60. Transcranial direct current stimulation priming of therapeutic repetitive transcranial magnetic stimulation: a pilot study. Loo C, D, Pigot M, Arul-Anandam P, P, Sachdev P. http://www.ncbi.nlm.nih.gov/pubmed/19440158 preconditioning with tDCS may greatly increase the pain experienced with subsequent rTMS.  F1000 Med Rep. 2009 Jul 27;1. pii: 58. Transcranial direct current stimulation - what is the evidence for its efficacy and safety? Arul-Anandam AP, Loo C, Sachdev P. http://www.ncbi.nlm.nih.gov/pubmed/20948722 A number of recent studies suggest that tDCS is safe and may be efficacious in the treatment of a variety of psychiatric and neurological disorders, including major depressive disorder, chronic neuropathic pain, and stroke. More evidence is necessary, however, before it can be recommended for general clinical application.  Clin Neurophysiol. 2009 Jun;120(6):1033-4. Epub 2009 Apr 24. Establishing safety limits for transcranial direct current stimulation. Bikson M, Datta A, Elwassif M. Comment on:    Clin Neurophysiol. 2009 Jun;120(6):1161-7. http://www.ncbi.nlm.nih.gov/pubmed/19394269  Clin Neurophysiol. 2009 Jun;120(6):1161-7. Epub 2009 Apr 28. Safety limits of cathodal transcranial direct current stimulation in rats. Liebetanz D, Koch R, Mayenfels S, König F, us W, Nitsche MA. http://www.ncbi.nlm.nih.gov/pubmed/19403329 N=58 rats. At tDCS intensity levels two orders of magnitude above those given to humans, the rats had no lesions. Although these results cannot be directly transferred to humans, they encourage the development of intensified tDCS protocols.  Clin Neurophysiol. 2009 Jan;120(1):80-4. Epub 2008 Nov 21. Bilateral frontal transcranial direct current stimulation: Failure to replicate classic findings in healthy subjects. Koenigs M, Ukueberuwa D, Campion P, Grafman J, Wassermann E. http://www.ncbi.nlm.nih.gov/pubmed/19027357 N=21; These results demonstrate the safety of bilateral anterior frontal TDCS with an extra-cephalic reference, but raise questions about its effectiveness as a modulator of mood and emotional cognition, at least in healthy subjects.  J Cogn Neurosci. 2008 Sep;20(9):1687-97. Cerebellar transcranial direct current stimulation impairs the practice-dependent proficiency increase in working memory. Ferrucci R, Marceglia S, Vergari M, Cogiamanian F, Mrakic-Sposta S, Mameli F, Zago S, Barbieri S, Priori A. http://www.ncbi.nlm.nih.gov/pubmed/18345990  Conf Proc IEEE Eng Med Biol Soc. 2009;2009:670-3. Bio-heat transfer model of transcranial DC stimulation: comparison of conventional pad versus ring electrode. Datta A, Elwassif M, Bikson M. http://www.ncbi.nlm.nih.gov/pubmed/19964238 The tissue temperature increases of tDCS using conventional rectangular-pad (7 x 5 cm(2)) and HD-tDCS using the ring (4 x 1) electrode configurations were compared using a bio-heat model. Our results indicate that clinical tDCS does not increase tissue temperature and 4 x 1 ring configurations leads to a negligible increase in scalp temperature.  Brain Res Bull. 2007 May 30;72(4-6):208-14. Epub 2007 Jan 24. Safety aspects of transcranial direct current stimulation concerning healthy subjects and patients. Poreisz C, Boros K, Antal A, us W. http://www.ncbi.nlm.nih.gov/pubmed/17452283 The aim of this paper is to summarize the partially adverse effects of 567 tDCS sessions over motor and non-motor cortical areas (occipital, temporal, parietal) from the last 2 years, on work performed in our laboratories. One-hundred and two of our subjects who participated in our tDCS studies completed a questionnaire. Participants were healthy subjects (75.5%), migraine patients (8.8%), post-stroke patients (5.9%) and tinnitus patients (9.8%). During tDCS a mild tingling sensation was the most common reported adverse effect (70.6%), moderate fatigue was felt by 35.3% of the subjects, whereas a light itching sensation under the stimulation electrodes occurred in 30.4% of cases. After tDCS headache (11.8%), nausea (2.9%) and insomnia (0.98%) were reported, but fairly infrequently. In addition, the incidence of the itching sensation (p=0.02) and the intensity of tingling sensation (p=0.02) were significantly higher during tDCS in the group of the healthy subjects, in comparison to patients; whereas the occurrence of headache was significantly higher in the patient group (p=0.03) after the stimulation. Our results suggest that tDCS applied to motor and non-motor areas according to the present tDCS safety guidelines, is associated with relatively minor adverse effects in healthy humans and patients with varying neurological disorders.  Clin Neurophysiol. 2007 May;118(5):1166-70. Epub 2007 Feb 27. Perception of comfort during transcranial DC stimulation: effect of NaCl solution concentration applied to sponge electrodes. Dundas JE, Thickbroom GW, Mastaglia FL. http://www.ncbi.nlm.nih.gov/pubmed/17329167 The application of NaCl solutions between 15 and 140 mM to sponge electrodes is more likely to be perceived as comfortable during tDCS. SIGNIFICANCE: The reporting of solution concentration and ratings of perception would be useful adjuncts to tDCS studies.  Neurology. 2005 Mar 8;64(5):872-5. Safety and cognitive effect of frontal DC brain polarization in healthy individuals. Iyer MB, Mattu U, Grafman J, Lomarev M, Sato S, Wassermann EM. http://www.ncbi.nlm.nih.gov/pubmed/15753425 There were no significant effects on performance with 1 mA DC. At 2 mA, verbal fluency improved significantly with anodal and decreased mildly with cathodal DC. There were no clinically significant effects on the other measures. CONCLUSIONS: Limited exposure to direct current polarization of the prefrontal cortex is safe and can enhance verbal fluency selectively in healthy subjects. As such, it deserves consideration as a procedure to improve frontal lobe function in patients.  Clin Neurophysiol. 2003 Nov;114(11):2220-2; author reply 2222-3. Safety criteria for transcranial direct current stimulation (tDCS) in humans. Nitsche MA, Liebetanz D, Lang N, Antal A, Tergau F, us W. http://www.ncbi.nlm.nih.gov/pubmed/14580622          Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 21, 2011 Report Share Posted August 21, 2011 On August 20, Jill Swartz asks about the tDCStim group and about Dave Siever's CES. Here are the details on tDCStim: Group home page: tDCStim Group email address: tDCStim I have Dave's CESta as well as a Chattanooga Ionto2 which I use for transcranial direct current stimulation - 1) as a standalone modality, 2) as an 'activation' technique prior to neurofeedback, or 3) to enhance motor or other learning - as in somatic work, musical training, language learning, etc. I would be pleased to discuss the differences if you post the question on the tDCStim group. I am sure that Pete's group has wide interests which would include your topics. But it is also true that to have these questions addressed in a tDCStim group will allow you to hear from other people who are using this modality and will also help concentrate the information for other investigators. Best wishes, Dailey Near San Francisco, CA From: [mailto: ] On Behalf Of j swartz Sent: Saturday, August 20, 2011 12:34 PM Subject: Re: tDCS is safe? Doug, I so appreciate your missives and would also appreciate if you would compare the tDCS with Dave Siever's CES. Also, is the tDCS group part of ? Thanks, Jill Swartz, , BC On Thu, Aug 11, 2011 at 6:56 AM, gary levine <garydrewlevine@...> wrote: Doug, Could you compare tDCS efficacy with cranial electric stim devices such as Alpha-Stim or the CES that is built into Dave Siever's auditory-visual entrainment devices? Sincerely, Levine On Thu, Aug 11, 2011 at 9:48 AM, Dailey <ddailey@...> wrote: Hello Bruce, Like usual, you have raised some interesting questions that warrant discussion. Please remember - my opinions are just theories - they are never true or false, but simply either useful or not useful. Being the well-qualified and busy pri Bactitioner that you are, you are aware that any intersection between ourselves and a client can be potentially hazardous. Even family counseling can have adverse repercussions that effect the health and well-being of several generations. We all take risks, patient and practitioner, in an informed way, if we are convinced, in each particular case, that the benefit outweighs the risk. I don't know about you, but I have never had a client that was in someone else's scientific study, where the experimental groups were chosen extremely strictly and usually had no comorbidities. Unlike the carefully selected subjects in the restrictive study, our real-life patients have messy complicated lives and are under the influence of multiple confounding factors. This is why medicine is an art - not a science. Try as we might, we may never fit each client into some statistical distribution of properties required for a controlled study. When we do - then it often becomes " For whom the bell-shaped curve tolls. " I can't even begin to tell you how many times people have been told that there is nothing wrong with them because each of their lab values fits into the plus and minus 2 standard deviations of the distribution seen in 'healthy' people. There are at least three flaws with this time saving (money making) approach. 1) The 'healthy' controls who are sampled are well on their own way to illness and are not followed; 2) just because your level of thyroid hormone (for example) has also been seen in the abstract group of " normals " , it does not follow that it is normal for you; 3) Our clients also differ from any of those in the abstract studies because they are usually receiving several types of other interventions which may include counseling, neuromodulation, medication, herbs and supplements, and toxic exposures at home or at work (not to mention toxic root canals, family history of schizophrenia and bipolar disorder, fibromyalgia, cerebrovascular disease, incipient diabetes and cancer and so forth). Every client is a mystery with his or her own hidden weaknesses. That is why, I would think, that our prime directive is " First of all - Do no harm. " As you pointed out, since we can't foresee the future, anything we do will have repercussions that continue long after we are gone. As you also pointed out, even meditation instruction can cause some clients to develop relaxation induced anxiety. Even worse, as Lee Sanella, MD, in his book " Kundalini - Psychosis or Transference? " pointed out, there is a long well-known appreciation in the literature that " meditation illness " is a common and debilitating disorder, often refractory to any treatment. So let's get back to tDCS. At the very bottom I will give you citations and abstracts for 22 studies on the safety of tDCS. These are more than you are likely to find regarding the safety of neurofeedback. And these are almost all studies done in major universities and published in a wide variety of peer reviewed journals. Let's look at the studies on tDCS and depression. I have included 22 citations and abstracts on this as well. Among other things, these studies have shown that treatment resistant, suicidal, hospitalized depressive who were given only 5 days of tDCS treatment were shown to do better at 6 week follow-up than similar depressives who responded well to drugs. There are several 'take home' lessons for me in these studies. One is that all the tDCS protocols for depression used the positive anode at F3 - the dorsolateral prefrontal cortex - exactly where neurofeedback usually targets its influence for depression, an area whose involvement is documented by fMRI and QEEG. The second lesson is that tDCS treats these regions in a way known to mimic normal physiological mechanisms - increasing or decreasing the excitability of neuronal pools by altering the charge difference between the inside and the outside of the neurons. The third lesson is that with tDCS there were no drug side effects and that 5 days of focused tDCS treatment exceeded the results of 6 weeks of daily drug use. In addition, the tDCS brought relief much more quickly than drugs. Bruce, nobody knows how or if tDCS, neurofeedback, and even, as you mentioned, coffee and meditation, might adversely affect current or future generations. There are many hundreds of studies documenting devastation due to pesticides, genetically modified foods, fragrances, pollution, lack of exercise, neglect, unpredictable stress, and impoverishment. Yet many people will not budge on their lifestyles. Once again it ends up being a risk-benefit analysis, such as we do all the time, and for which, as professionals, we must be constantly educating ourselves. I will very quickly summarize the tDCS safety information, although I suggest you consult the sources. tDCS can cause a burn to the skin. This rarely occurs because clients will comment if they feel discomfort; but it is a risk for those will lowered skin sensitivity. There were two cases where bipolar depression was lifted but hypomania ensued. That has not occurred since a new electrode montage has become standard. Otherwise, the only 'side effects' are tingling and itching and occasional momentary headache, all of which can be relieved by reducing the current. The investigators could not reduce the current in the studies or the math would have been thrown off - so some subjects had to endure 20 minutes of fire ants on their scalps. In the clinic you set the current for comfort, even if it means you extend your treatment time by a few minutes. I hope this has helped you answer your question yourself. I believe that I know from our conversations how carefully and strictly you want to use your tools. Otherwise how could we judge our results. I would be happy to contact you back channel if you are interested in tDCS. Its documented ability to improve cortical glucose tolerance, neuroplasticity, neuroprotection, and learning make it an exceptionally fine tool to use prior to neurofeedback, or simultaneously with HEG and HRV. I invite you, and any other readers, to join the absolutely new group on tDCStim. At present there are only a handful of members; but it is the only English language tDCS group, and the only active tDCS group anywhere. Being a member will ensure that you will get updates on new studies and that you can talk about tDCS with other experts who have an interest in neurofeedback as well. Group home page: tDCStim Group email address: tDCStim Best wishes, Dailey ---------------------------- Studies on Depression J Affect Disord. 2011 Jun 2. Fronto-extracephalic transcranial direct current stimulation as a treatment for major depression: An open-label pilot study. DM, Alonzo A, PB, Sachdev P, Gálvez V, Loo CK. http://www.ncbi.nlm.nih.gov/pubmed/21641047 BACKGROUND: Several recent trials have reported transcranial direct current stimulation (tDCS) to be effective in treating depression, though the relative benefits of different electrode montages remain unexplored. Whereas all recent studies have used a bifrontal (BF) electrode montage, studies published in the 1960s and 1970s placed one electrode in an extracephalic position, with some positive reports of efficacy. This study investigated the efficacy and safety of tDCS given with a fronto-extracephalic (F-EX) montage. METHODS: 2mA tDCS was administered for 20min every weekday over four weeks in 11 participants with a Major Depressive Episode who had previously shown inadequate response to, or relapsed following, a course of BF tDCS. For F-EX tDCS the anode was placed on the left dorsolateral prefrontal cortex and the cathode on the right upper arm. Depression severity and neuropsychological function were assessed before and after the treatment course. Antidepressant response was compared across an equivalent treatment period for both montages. RESULTS: F-EX tDCS was shown to be safe and well tolerated. Depression ratings improved after acute treatment on the Montgomery Åsberg Depression Rating Scale (p<0.001). Participants showed greater initial treatment response with F-EX tDCS than with BF tDCS (p<0.001). LIMITATIONS: This was an open label pilot study. The two comparison treatments were applied consecutively. CONCLUSION: F-EX tDCS appears to be safe and to have antidepressant effects, and may lead to more rapid improvement than tDCS given with a BF montage. Eur Psychiatry. 2011 May 27. Transcranial direct current stimulation for the outpatient treatment of poor-responder depressed patients. Dell'osso B, Zanoni S, Ferrucci R, Vergari M, Castellano F, D'Urso N, Dobrea C, Benatti B, Arici C, Priori A, Altamura AC. http://www.ncbi.nlm.nih.gov/pubmed/21621982 Transcranial direct current stimulation (tDCS) is a selective, painless, brain stimulation technique that allows the electric stimulation of specific cortical regions. TDCS has been recently used as investigational intervention for major depression and treatment resistant depression (TRD) with encouraging results. The present study was aimed to investigate the efficacy and tolerability of tDCS in major depressives with poor response to pharmacological treatment. Twenty-three depressed patients, with a diagnosis of major depressive disorder or bipolar disorder, were treated with augmentative tDCS for 5 days, two sessions per day in a blind-rater trial. The course of depressive symptoms was analyzed using repeated measures ANOVA for HAM-D and MADRS total scores. A qualitative analysis on the basis of the HAM-D response was performed as well. Both analyses were conducted at three time-points: T0 (baseline), T1 (endpoint tDCS) and T2 (end of the first week of follow-up). All patients completed the trial without relevant side-effects. A significant reduction of HAM-D and MADRS total scores was observed during the study (P<0.0001). Treatment response (endpoint HAM-D reduction ≥50%) was obtained by four patients (17.4%) at T1 and by seven patients (30.4%) at T2 and remission (endpoint HAM-D<8) by three patients (13.0%) at T1 and by four subjects (17.4%) at T2. Present findings support the efficacy and good tolerability of tDCS in the acute treatment of patients with TRD with clinical benefit being progressive and extended to the first week of follow-up. Further sham-controlled trials with longer follow-up are needed to confirm present results. Neurocase. 2011 Jan 6:1-5. [Epub ahead of print] Mood and cognitive effects of transcranial direct current stimulation in post-stroke depression. Bueno VF, Brunoni AR, Boggio PS, Bensenor IM, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/21213180 Here, we report a patient with significant mood and cognitive impairment who showed marked amelioration of these symptoms following anodal stimulation (2 mA per 30 minutes per 10 days) over the left dorsolateral prefrontal cortex. Prog Neuropsychopharmacol Biol Psychiatry. 2011 Jan 15;35(1):96-101. Epub 2010 Sep 18. Transcranial direct current stimulation (tDCS) in unipolar vs. bipolar depressive disorder. Brunoni AR, http://www.ncbi.nlm.nih.gov/pubmed/20854868 We applied tDCS over the dorsolateral prefrontal cortex (anodal electrode on the left and cathodal on the right) using a 2 mA-current for 20 min, twice-daily, for 5 consecutive days. Depression was measured at baseline, after 5 tDCS sessions, one week later, and one month after treatment onset. We used the scales of Beck (BDI) and Hamilton-21 items (HDRS). All patients tolerated treatment well without adverse effects. After the fifth tDCS session, depressive symptoms in both study groups diminished, and the beneficial effect persisted at one week and one month. In conclusion, our preliminary study suggests that tDCS is a promising treatment for patients with MDD and BDD. Neurocase. 2011 Jan 6:1-5. [Epub ahead of print] Mood and cognitive effects of transcranial direct current stimulation in post-stroke depression. Bueno VF, Brunoni AR, Boggio PS, Bensenor IM, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/21213180 " marked amelioration of these symptoms following anodal stimulation (2 mA per 30 minutes per 10 days) over the left dorsolateral prefrontal cortex. " Int J Neuropsychopharmacol. 2010 Feb;13(1):61-9. Epub 2009 Aug 12. A double-blind, sham-controlled trial of transcranial direct current stimulation for the treatment of depression. Loo CK, Sachdev P, D, Pigot M, Alonzo A, Malhi GS, Lagopoulos J, P. http://www.ncbi.nlm.nih.gov/pubmed/19671217 N=40; This double-blind, randomized study tested tDCS at the same stimulation parameters as a previous positive study (1 mA current strength, five treatment sessions, active or sham, given on alternate days) in 40 depressed participants. Anodal stimulation was centered over the left dorsolateral prefrontal cortex, with the cathode placed on the lateral aspect of the contralateral orbit. tDCS was continued up to a total of ten active sessions per participant. Overall depression scores improved significantly over ten tDCS treatments... tDCS was found to be safe, with no adverse effects on neuropsychological function, and only minor side-effects. Arq Neuropsiquiatr. 2010 Jun;68(3):433-51. Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting. Brunoni AR, Teng CT, Correa C, Imamura M, Brasil-Neto JP, Boechat R, M, Caramelli P, Cohen R, Del Porto JA, Boggio PS, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/20602051 J Affect Disord. 2009 Nov;118(1-3):215-9. Epub 2009 Mar 16. Transcranial direct current stimulation in severe, drug-resistant major depression. Ferrucci R, Bortolomasi M, Vergari M, Tadini L, Salvoro B, Giacopuzzi M, Barbieri S, Priori A. http://www.ncbi.nlm.nih.gov/pubmed/19286265 N=14 hospitalized MDD with high suicide risk and referred for ECT. . tDCS was delivered over the dorsolateral prefrontal cortex (DLPC) (2 mA, 20 min, anode left, cathode right) twice a day. After five days of treatment although cognitive performances remained unchanged, the BDI and HDRS scores improved more than 30% (BDI p=0.001; HDRS p=0.017). The mood improvement persisted and even increased at four (T2) weeks after treatment ended. We conclude that frontal tDCS is a simple, promising technique that can be considered in clinical practice as adjuvant treatment for hospitalized patients with severe, drug-resistant major depression. J Affect Disord. 2009 Oct;117(3):137-45. Epub 2009 Feb 7. Transcranial direct current stimulation: a new tool for the treatment of depression? Arul-Anandam AP, Loo C. http://www.ncbi.nlm.nih.gov/pubmed/19201483 We briefly review tDCS clinical trials for MDD, and then consider its mechanisms of action, identifying potential avenues for future research. Exp Neurol. 2009 Sep;219(1):14-9. Epub 2009 Apr 5. Treatment of depression with transcranial direct current stimulation (tDCS): a review. Nitsche MA, Boggio PS, Fregni F, Pascual-Leone A. http://www.ncbi.nlm.nih.gov/pubmed/19348793 Major Depression Disorder (MDD) is usually accompanied by alterations of cortical activity and excitability, especially in prefrontal areas. These are reflections of a dysfunction in a distributed cortico-subcortical, bihemispheric network. Early studies from the 1960s suggested some efficacy of DC stimulation to reduce symptoms in depression, but mixed results and development of psychotropic drugs resulted in an early abandonment of this technique. In the last years tDCS protocols have been optimized. Application of the newly developed stimulation protocols in patients with major depression has shown promise in few pilot studies. Curr Opin Psychiatry. 2009 May;22(3):306-11. Transcranial direct current stimulation as a therapeutic tool for the treatment of major depression: insights from past and recent clinical studies. DN, Boggio P, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/19339889 tDCS is associated with significant clinical gains. ... it appears that current methods of tDCS might not be fully optimized and, in fact, (1) individualized parameters of stimulation, (2) longer stimulation sessions, and (3) methods to focalize tDCS might be useful strategies to provide greater clinical benefits. Rev Bras Psiquiatr. 2009 May;31 Suppl 1:S34-8. Transcranial direct current stimulation: a promising alternative for the treatment of major depression? Berlim MT, Dias Neto V, Turecki G. http://www.ncbi.nlm.nih.gov/pubmed/19565150 Current protocols for the treatment of major depression with transcranial direct current stimulation usually involve the application of two sponge-electrodes in the scalp. In general, the positive electrode is applied in the region above the left dorsolateral prefrontal cortex (i.e., F3 region of the 10/20 International System for EEG) and the negative electrode is applied in the region above the right supra-orbital area. A direct electrical current of 1-2 mA is then applied between the electrodes for about 20 minutes, with sessions being daily performed for one to two weeks. Recent studies show that transcranial direct current stimulation is an important neuromodulatory method that may be useful for the treatment of depressed patients. Ther Clin Risk Manag. 2009;5:897-910. Epub 2009 Nov 18. Pharmacological and combined interventions for the acute depressive episode: focus on efficacy and tolerability. Brunoni AR, Fraguas R, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/19956554 A search was undertaken in MEDLINE, Web of Science, Cochrane, and Scielo databases. We included: 21 meta-analyses of antidepressant trials, 15 neurostimulation clinical trials and 8 studies of pharmacoeconomics. These therapies might be interesting augmentation strategies, considering their benign profile of side effects, if proper safety parameters are adopted. World J Biol Psychiatry. 2009;10(4 Pt 2):632-5. Transcranial direct current stimulation in a patient with therapy-resistant major depression. Palm U, Keeser D, Schiller C, Fintescu Z, Reisinger E, Baghai TC, Mulert C, Padberg F. http://www.ncbi.nlm.nih.gov/pubmed/19995213 N=1; female patient suffering from recurrent major depressive episodes who underwent anodal tDCS of the left dorsolateral PFC over 4 weeks as an add-on treatment. Only a modest improvement of depressive symptoms was observed after tDCS,... However, there was an increase from 52 to 90% in the Regensburg Verbal Fluency Test. Low resolution brain electromagnetic tomography (LORETA) showed a left unilateral focal effect (25-40% reduced power) in the delta, theta and alpha frequency bands. The same effect appeared in the surface analysis of the EEG. The absolute, as well as the relative power decreased significantly in the delta, theta and alpha bands after a comparison of the spectral analysis. Curr Psychiatry Rep. 2008 Dec;10(6):465-73. Novel targets for antidepressant therapies. Holtzheimer PE, Nemeroff CB. http://www.ncbi.nlm.nih.gov/pubmed/18980729 Curr Treat Options Neurol. 2008 Sep;10(5):377-85. Transcranial direct current stimulation for major depression: a general system for quantifying transcranial electrotherapy dosage. Bikson M, Bulow P, Stiller JW, Datta A, Battaglia F, Karnup SV, Postolache TT. http://www.ncbi.nlm.nih.gov/pubmed/18782510 If tDCS can be established as an effective treatment for depression, it would represent a particularly attractive electrotherapy option, as it is a relatively benign and affordable treatment modality. An accurate system for describing reproducible treatment parameters is essential so that further studies can yield evidence-based guidelines for the clinical use of transcranial current stimulation Int J Neuropsychopharmacol. 2008 Mar;11(2):249-54. Epub 2007 Jun 11. A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. Boggio PS, Rigonatti SP, Ribeiro RB, Myczkowski ML, Nitsche MA, Pascual-Leone A, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/17559710 N=40; 10 sessions over a 2 week period of anodal tDCS to the left dorsolateral prefrontal cortex lead to " significantly larger reductions in depression scores after DLPFC tDCS. ...The beneficial effects of tDCS in the DLPFC group persisted for 1 month after the end of treatment Eur Psychiatry. 2008 Jan;23(1):74-6. Epub 2007 Nov 19. Transcranial direct stimulation and fluoxetine for the treatment of depression. Rigonatti SP, Boggio PS, Myczkowski ML, Otta E, Fiquer JT, Ribeiro RB, Nitsche MA, Pascual-Leone A, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/18023968 N=42; Patients were moderately depressed, off medication for two month. We compared the findings of a parallel-group, randomized, double-blind clinical trial investigating the effects of active vs. sham tDCS with an open-label trial in which patients with similar clinical characteristics received fluoxetine, a frequently prescribed serotonin reuptake inhibitor.Protocol: 2 mA of intensity for 20 min for 10 days (anodal electrode on the left dorsolateral prefrontal cortex and cathode electrode on the contralateral supraorbital area). All patients were assessed at baseline and after 2, 4, and 6 weeks after the onset of treatment (tDCS or fluoxetine). Results: the antidepressant effects of non-invasive brain stimulation with tDCS are similar to those of a 6-week course of fluoxetine at a relatively small dose of 20 mg/day. However, the antidepressant benefit of tDCS appears to become significant faster than the benefit of fluoxetine. J Affect Disord. 2007 Aug;101(1-3):91-8. Epub 2006 Dec 12. Go-no-go task performance improvement after anodal transcranial DC stimulation of the left dorsolateral prefrontal cortex in major depression. Boggio PS, Bermpohl F, Vergara AO, Muniz AL, Nahas FH, Leme PB, Rigonatti SP, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/17166593 ....anodal stimulation of the left DLPFC was the only condition that induced a significant improvement in task performance as shown by the increase in the number of correct responses. In addition, this effect was specific for figures with positive emotional content. This performance enhancement was not correlated with mood changes after 10 days of tDCS treatment. Clin EEG Neurosci. 2007 Apr;38(2):105-15. Transcranial and deep brain stimulation approaches as treatment for depression. Rau A, Grossheinrich N, Palm U, Pogarell O, Padberg F. http://www.ncbi.nlm.nih.gov/pubmed/17515176 Several brain stimulation approaches are currently being investigated as novel therapeutic interventions beside electroconvulsive therapy (ECT), a prototypic method in this field with proven effectiveness. These neurostimulation methods include repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST), vagus nerve stimulation (VNS), deep brain stimulation (DBS) and transcranial direct current stimulation (tDCS). It is via different neuroanatomically defined " windows " that the various approaches access the neuronal networks showing an altered function in depression. Also, the methods vary regarding their degree of invasiveness. One or the other method may finally achieve antidepressant effectiveness with minimized side effects and constitute a new effective treatment for major depression. Bipolar Disord. 2006 Apr;8(2):203-4. Treatment of major depression with transcranial direct current stimulation. Fregni F, Boggio PS, Nitsche MA, Marcolin MA, Rigonatti SP, Pascual-Leone A. http://www.ncbi.nlm.nih.gov/pubmed/16542193 N=10; tDCS was applied through a saline-soaked pair of surface sponge electrodes (35 cm2). The anode electrode was placed over F3 (10–20 International EEG System) of each subject. The cathode was placed over the contralateral supraorbital area. A constant current of 1 mA strength was applied for 20 min/day (administered for five alternated days). All patients tolerated tDCS without complications. At the end of treatment, there were four treatment responders in the active group versus no responders in the sham group. This treatment is inexpensive, easy to administer, non-invasive and painless. Depress Anxiety. 2006;23(8):482-4. Cognitive effects of repeated sessions of transcranial direct current stimulation in patients with depression. Fregni F, Boggio PS, Nitsche MA, Rigonatti SP, Pascual-Leone A. http://www.ncbi.nlm.nih.gov/pubmed/16845648 The clinical utility of transcranial direct current stimulation (tDCS) has been discussed and explored for almost 40 years....recent investigations using different electrodes size and position, and different stimulation parameters have demonstrated that this technique is a robust method to modulate brain excitability probably on the basis of shifts in neuronal membrane excitability in patients with major depression. In this trial, we investigated the cognitive effects of 5 days of anodal stimulation of the left DLPFC in 18 patients with major depression. A neuropsychological battery was assessed immediately before the first day of treatment and immediately after the last treatment day (fifth session). The anode electrode was placed over F3 (10–20 International EEG System) of each subject. The cathode (reference electrode) was placed over the contralateral supraorbital area. A constant current of 1-mA strength was applied for 20 minutes per day (administered for 5 alternate days) during the morning (8:00 to 10:00 A.M.). Repeated sessions of active tDCS do not result in cognitive impairment compared to placebo tDCS in patients with major depression; on the contrary, they appear able to improve one aspect of cognitive function—working memory. This cognitive enhancement was not observed after sham tDCS and was not correlated with mood effects. This is in line with a previous study that showed an enhancement of working memory after a single session of tDCS of the left DLPFC in healthy subjects --------------------------- Studies on Safety Biol Psychiatry. 2011 Apr 15;69(8):e23-4. Epub 2011 Feb 18. Efficacy and safety of transcranial direct current stimulation in major depression. Dell'osso B, Priori A, Altamura AC. http://www.ncbi.nlm.nih.gov/pubmed/21310394 Int J Neuropsychopharmacol. 2011 Feb 15:1-13. [Epub ahead of print] A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. Brunoni AR, Amadera J, Berbel B, Volz MS, Rizzerio BG, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/21320389 J ECT. 2011 Jan 4. [Epub ahead of print] Hypomania Induction in a Patient With Bipolar II Disorder by Transcranial Direct Current Stimulation (tDCS). Gálvez V, Alonzo A, D, PB, Sachdev P, Loo CK. http://www.ncbi.nlm.nih.gov/pubmed/21206371 participated in a clinical trial of tDCS given with a bifrontal electrode montage for the treatment of major depression without incident, but became hypomanic when she received a later course of tDCS given with a frontoextracephalic configuration. Int J Neuropsychopharmacol. 2011 Apr;14(3):425-6. Epub 2010 Oct 6. Avoiding skin burns with transcranial direct current stimulation: preliminary considerations. Loo CK, DM, Alonzo A, Gandevia S, PB, Sachdev P. School of Psychiatry, University of New South Wales, Sydney, Australia. http://www.ncbi.nlm.nih.gov/pubmed/20923600 J ECT. 2011 Jan 4. [Epub ahead of print] Hypomania Induction in a Patient With Bipolar II Disorder by Transcranial Direct Current Stimulation (tDCS). Gálvez V, Alonzo A, D, PB, Sachdev P, Loo CK. http://www.ncbi.nlm.nih.gov/pubmed/21206371 We report the case of a 33-year-old female with bipolar II disorder, on mood stabilizer medication, who had previously participated in a clinical trial of tDCS given with a bifrontal electrode montage for the treatment of major depression without incident, but became hypomanic when she received a later course of tDCS given with a frontoextracephalic configuration. When the reference cathodal electrode in tDCS is moved from the cranium to an extracephalic position, larger areas of both cerebral hemispheres are stimulated, with potential implications for both efficacy and safety. In particular, it raises the question of whether frontoextracephalic tDCS requires additional precautions when administered to bipolar patients compared to bifrontal tDCS Brain Stimul. 2011 Jan;4(1):38-42. Epub 2010 Jun 17. Reducing procedural pain and discomfort associated with transcranial direct current stimulation. McFadden JL, Borckardt JJ, MS, Beam W. Brain Stimulation Laboratory, Medical University of South Carolina, ton, South Carolina, USA. http://www.ncbi.nlm.nih.gov/pubmed/21255753 Though tDCS as presently applied causes no apparent harm to brain structure or function, a number of uncomfortable sensations can occur beneath the electrodes during stimulation, including tingling, pain, itching, and burning sensations. Therefore, we investigated the effect of topically applied Eutectic mixture of local anesthetics (EMLA) on tDCS-related discomfort. On average, the mean sensation ratings for EMLA-associated tDCS stimulation were significantly lower than placebo-associated stimulation for every cutaneous sensation evaluated. Cathodal stimulation was associated with higher ratings of " sharpness " and intolerability than anodal stimulation. J ECT. 2010 Oct 5. [Epub ahead of print] Cognitive, Mood, and Electroencephalographic Effects of Noninvasive Cortical Stimulation With Weak Electrical Currents. Tadini L, El-Nazer R, Brunoni AR, J, Carvas M, Boggio P, Priori A, Pascual-Leone A, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/20938352 Here, we show no neurophysiological or behavioral signs that transcranial DC stimulation or AC stimulation with weak currents induce deleterious changes when comparing active and sham groups. This study provides therefore additional information for researchers and ethics committees, adding important results to the safety pool of studies assessing the effects of cortical stimulation using weak electrical currents. Further studies in patients with neuropsychiatric disorders are warranted. Neuroimage. 2010 Oct 1;52(4):1268-78. Epub 2010 May 7. Transcranial direct current stimulation in patients with skull defects and skull plates: high-resolution computational FEM study of factors altering cortical current flow. Datta A, Bikson M, Fregni F. http://www.ncbi.nlm.nih.gov/pubmed/20435146 As the conductivity of large skull defects/plates was increased (chronic to acute to titanium), current was shunted away from directly underlying cortex and concentrated in cortex underlying the defect perimeter. The predictions of this study are the first step to assess safety of transcranial electrical therapy in subjects with skull injuries and skull plates. BMC Neurosci. 2010 Mar 16;11:38. Effect of tDCS with an extracephalic reference electrode on cardio-respiratory and autonomic functions. Vandermeeren Y, Jamart J, Ossemann M. http://www.ncbi.nlm.nih.gov/pubmed/20233439 Applying tDCS with an extracephalic reference electrode in healthy volunteers did not significantly modulate the activity of the brainstem autonomic centres. Therefore, using an extracephalic reference electrode for tDCS appears safe in healthy volunteers, at least under similar experimental conditions. J ECT. 2010 Mar;26(1):68-9. Induction of hypomanic episode with transcranial direct current stimulation. Arul-Anandam AP, Loo C, P. http://www.ncbi.nlm.nih.gov/pubmed/19483641 We report on the case of a 57-year-old man who experienced an episode of hypomania while participating in a clinical trial of transcranial direct current stimulation for the treatment of major depressive disorder. Although hypomania and mania have been reported after transcranial magnetic stimulation to the dorsolateral prefrontal cortex in the past, to our knowledge, this is the first report of mania after transcranial direct current stimulation to the dorsolateral prefrontal cortex. Brain Stimul. 2010 Jan;3(1):58-9. Epub 2009 May 20. Anodal skin lesions after treatment with transcranial direct current stimulation. E, Wilfurth S, Landgrebe M, Eichhammer P, Hajak G, Langguth B. http://www.ncbi.nlm.nih.gov/pubmed/20633432 J ECT. 2009 Dec;25(4):256-60. Transcranial direct current stimulation priming of therapeutic repetitive transcranial magnetic stimulation: a pilot study. Loo C, D, Pigot M, Arul-Anandam P, P, Sachdev P. http://www.ncbi.nlm.nih.gov/pubmed/19440158 preconditioning with tDCS may greatly increase the pain experienced with subsequent rTMS. F1000 Med Rep. 2009 Jul 27;1. pii: 58. Transcranial direct current stimulation - what is the evidence for its efficacy and safety? Arul-Anandam AP, Loo C, Sachdev P. http://www.ncbi.nlm.nih.gov/pubmed/20948722 A number of recent studies suggest that tDCS is safe and may be efficacious in the treatment of a variety of psychiatric and neurological disorders, including major depressive disorder, chronic neuropathic pain, and stroke. More evidence is necessary, however, before it can be recommended for general clinical application. Clin Neurophysiol. 2009 Jun;120(6):1033-4. Epub 2009 Apr 24. Establishing safety limits for transcranial direct current stimulation. Bikson M, Datta A, Elwassif M. Comment on: Clin Neurophysiol. 2009 Jun;120(6):1161-7. http://www.ncbi.nlm.nih.gov/pubmed/19394269 Clin Neurophysiol. 2009 Jun;120(6):1161-7. Epub 2009 Apr 28. Safety limits of cathodal transcranial direct current stimulation in rats. Liebetanz D, Koch R, Mayenfels S, König F, us W, Nitsche MA. http://www.ncbi.nlm.nih.gov/pubmed/19403329 N=58 rats. At tDCS intensity levels two orders of magnitude above those given to humans, the rats had no lesions. Although these results cannot be directly transferred to humans, they encourage the development of intensified tDCS protocols. Clin Neurophysiol. 2009 Jan;120(1):80-4. Epub 2008 Nov 21. Bilateral frontal transcranial direct current stimulation: Failure to replicate classic findings in healthy subjects. Koenigs M, Ukueberuwa D, Campion P, Grafman J, Wassermann E. http://www.ncbi.nlm.nih.gov/pubmed/19027357 N=21; These results demonstrate the safety of bilateral anterior frontal TDCS with an extra-cephalic reference, but raise questions about its effectiveness as a modulator of mood and emotional cognition, at least in healthy subjects. J Cogn Neurosci. 2008 Sep;20(9):1687-97. Cerebellar transcranial direct current stimulation impairs the practice-dependent proficiency increase in working memory. Ferrucci R, Marceglia S, Vergari M, Cogiamanian F, Mrakic-Sposta S, Mameli F, Zago S, Barbieri S, Priori A. http://www.ncbi.nlm.nih.gov/pubmed/18345990 Conf Proc IEEE Eng Med Biol Soc. 2009;2009:670-3. Bio-heat transfer model of transcranial DC stimulation: comparison of conventional pad versus ring electrode. Datta A, Elwassif M, Bikson M. http://www.ncbi.nlm.nih.gov/pubmed/19964238 The tissue temperature increases of tDCS using conventional rectangular-pad (7 x 5 cm(2)) and HD-tDCS using the ring (4 x 1) electrode configurations were compared using a bio-heat model. Our results indicate that clinical tDCS does not increase tissue temperature and 4 x 1 ring configurations leads to a negligible increase in scalp temperature. Brain Res Bull. 2007 May 30;72(4-6):208-14. Epub 2007 Jan 24. Safety aspects of transcranial direct current stimulation concerning healthy subjects and patients. Poreisz C, Boros K, Antal A, us W. http://www.ncbi.nlm.nih.gov/pubmed/17452283 The aim of this paper is to summarize the partially adverse effects of 567 tDCS sessions over motor and non-motor cortical areas (occipital, temporal, parietal) from the last 2 years, on work performed in our laboratories. One-hundred and two of our subjects who participated in our tDCS studies completed a questionnaire. Participants were healthy subjects (75.5%), migraine patients (8.8%), post-stroke patients (5.9%) and tinnitus patients (9.8%). During tDCS a mild tingling sensation was the most common reported adverse effect (70.6%), moderate fatigue was felt by 35.3% of the subjects, whereas a light itching sensation under the stimulation electrodes occurred in 30.4% of cases. After tDCS headache (11.8%), nausea (2.9%) and insomnia (0.98%) were reported, but fairly infrequently. In addition, the incidence of the itching sensation (p=0.02) and the intensity of tingling sensation (p=0.02) were significantly higher during tDCS in the group of the healthy subjects, in comparison to patients; whereas the occurrence of headache was significantly higher in the patient group (p=0.03) after the stimulation. Our results suggest that tDCS applied to motor and non-motor areas according to the present tDCS safety guidelines, is associated with relatively minor adverse effects in healthy humans and patients with varying neurological disorders. Clin Neurophysiol. 2007 May;118(5):1166-70. Epub 2007 Feb 27. Perception of comfort during transcranial DC stimulation: effect of NaCl solution concentration applied to sponge electrodes. Dundas JE, Thickbroom GW, Mastaglia FL. http://www.ncbi.nlm.nih.gov/pubmed/17329167 The application of NaCl solutions between 15 and 140 mM to sponge electrodes is more likely to be perceived as comfortable during tDCS. SIGNIFICANCE: The reporting of solution concentration and ratings of perception would be useful adjuncts to tDCS studies. Neurology. 2005 Mar 8;64(5):872-5. Safety and cognitive effect of frontal DC brain polarization in healthy individuals. Iyer MB, Mattu U, Grafman J, Lomarev M, Sato S, Wassermann EM. http://www.ncbi.nlm.nih.gov/pubmed/15753425 There were no significant effects on performance with 1 mA DC. At 2 mA, verbal fluency improved significantly with anodal and decreased mildly with cathodal DC. There were no clinically significant effects on the other measures. CONCLUSIONS: Limited exposure to direct current polarization of the prefrontal cortex is safe and can enhance verbal fluency selectively in healthy subjects. As such, it deserves consideration as a procedure to improve frontal lobe function in patients. Clin Neurophysiol. 2003 Nov;114(11):2220-2; author reply 2222-3. Safety criteria for transcranial direct current stimulation (tDCS) in humans. Nitsche MA, Liebetanz D, Lang N, Antal A, Tergau F, us W. http://www.ncbi.nlm.nih.gov/pubmed/14580622 Quote Link to comment Share on other sites More sharing options...
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