RESUMO
OBJECTIVES: We aimed to assess the safety and efficacy of transcranial direct current stimulation (tDCS) in patients with systemic autoimmune myopathies (SAMs). METHODS: This prospective, randomised, sham-controlled, double-blind, study included 20 patients with SAMs allocated to receive sham or active tDCS (2mA, 20 minutes, 3 days). Electrodes were positioned with the anode over the C1 or C2, whereas the cathode was placed over the Fp2 or Fp1, respectively. The groups were evaluated in four periods with specific questionnaires and functional tests: pre-stimulation and after 30 minutes, three weeks, and eight weeks post-tDCS. RESULTS: Two patients from the sham group withdrew after the three sessions. The demographic data, type of myositis, disease duration, and disease status were comparable between the active and sham tDCS groups. After interventions, in the active tDCS group, the physical aspects of SF-36 in week eight, mean and better timed up-and-go test at each evaluation, peak torque of stimulated inferior limb extension improved significantly (p<0.05). The emotional aspect of SF-36 decreased only in the active tDCS group (p<0.001). The patients' adherence to the protocol was 100% and no serious adverse event was reported, including disease relapses. CONCLUSIONS: This study evidences the safety of tDCS, as well as its potential efficacy in improving muscle strength and function in SAMs patients. More studies with a larger sample and longer tDCS sessions are necessary to corroborate the results of the present study.
Assuntos
Doenças Musculares , Estimulação Transcraniana por Corrente Contínua , Humanos , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Estimulação Transcraniana por Corrente Contínua/métodos , Estudos Prospectivos , Método Duplo-Cego , EmoçõesRESUMO
Background: Transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (DLPFC) may reduce appetite and caloric intake and may be able to play a role as an adjunct treatment for obesity. Stimulation of this brain area is also used for the treatment of depression, which shares a common pathophysiology with obesity. As a result, the effect of tDCS on mental health and its impact on the quality of life of subjects with excess weight needs to be addressed.Objective: To assess the effect of daily tDCS of the right DLPFC on mood, daytime sleepiness, anxiety and quality of life in subjects with excess weight on a hypocaloric diet.Methods: We randomly assigned 28 subjects to receive 20 sessions of active or sham tDCS over the right DLPFC for 20 consecutive weekdays. The severity of depressive and anxiety symptoms was assessed by the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory-State (STAI-S). Sleepiness was measured by a daytime sleepiness questionnaire (DSQ), and quality of life was measured by the 36-Item Short Form Health Survey (SF-36).Results: There were no significant changes in BDI, STAI-S and DSQ scores between groups, even after adjustments for the use of antidepressant medications and changes in body weight. There were also no significant changes in different subscales of the SF-36 quality of life questionnaire between groups.Conclusion: Repetitive tDCS on the right DLPFC is not associated with impairment in mental health or quality of life in overweight and obese subjects.
Assuntos
Restrição Calórica , Sobrepeso/psicologia , Sobrepeso/terapia , Escalas de Graduação Psiquiátrica , Estimulação Transcraniana por Corrente Contínua , Adulto , Ansiedade/fisiopatologia , Ansiedade/terapia , Depressão/terapia , Córtex Pré-Frontal Dorsolateral/fisiopatologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Obesidade/fisiopatologia , Obesidade/psicologia , Obesidade/terapia , Sobrepeso/fisiopatologia , Estimulação Transcraniana por Corrente Contínua/efeitos adversosRESUMO
INTRODUCTION: Major depressive disorder (MDD) is a prevalent and debilitating condition. First-line treatments include antidepressants and cognitive-behavioral psychotherapy (CBT). However, several patients present treatment-resistance and/or adverse effects. Transcranial direct current stimulation (tDCS), a noninvasive neuromodulation technique, is an effective alternative for MDD. AREAS COVERED: We hereby review a portable tDCS device designed to be combined with a cognitive-behavioral intervention. This home-use device was developed by Flow Neuroscience™ and was recently approved in the UK and European Union. We discuss present evidence on tDCS efficacy and safety, both as a monotherapy and as a combined treatment. Moreover, we show a computer modeling tDCS procedure based on Flow parameters and montage. EXPERT OPINION: Electric field simulations revealed that Flow's tDCS device targets prefrontal cortical areas involved in MDD pathophysiology. In addition, the safety and efficacy profile revealed from prior tDCS studies support its use in depression. Finally, combining tDCS with cognitive-behavioral interventions might further enhance overall efficacy, although this aspect should be investigated in upcoming randomized, placebo-controlled trials.
Assuntos
Depressão/terapia , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Estimulação Transcraniana por Corrente Contínua/instrumentação , Terapia Cognitivo-Comportamental , Desenho de Equipamento , Humanos , Resultado do TratamentoRESUMO
Importance: Negative symptoms represent a substantial burden in schizophrenia. Although preliminary studies have suggested that transcranial direct current stimulation (tDCS) is effective for some clusters of symptoms, the clinical benefits for negative symptoms are unclear. Objective: To determine the efficacy and safety of tDCS vs sham as an add-on treatment for patients with schizophrenia and predominant negative symptoms. Design, Setting, and Participants: The double-blind Schizophrenia Treatment With Electric Transcranial Stimulation (STARTS) randomized clinical trial was conducted from September 2014 to March 2018 in 2 outpatient clinics in the state of São Paulo, Brazil. Patients with schizophrenia with stable negative and positive symptoms and a minimum score of 20 points in the negative symptoms subscale of the Positive and Negative Syndrome Scale (PANSS) were included. Interventions: Ten sessions of tDCS performed twice a day for 5 days or a sham procedure. The anode and the cathode were positioned over the left prefrontal cortex and the left temporoparietal junction, respectively. Main Outcomes and Measures: Change in the PANSS negative symptoms subscale score at week 6 was the primary outcome. Patients were followed-up for an additional 6 weeks. Results: Of the 100 included patients, 20 (20.0%) were female, and the mean (SD) age was 35.3 (9.3) years. A total of 95 patients (95.0%) finished the trial. In the intention-to-treat analysis, patients receiving active tDCS showed a significantly greater improvement in PANSS score compared with those receiving the sham procedure (difference, 2.65; 95% CI, 1.51-3.79; number needed to treat, 3.18; 95% CI, 2.12-6.99; P < .001). Response rates for negative symptoms (20% improvement or greater) were also higher in the active group (20 of 50 [40%]) vs the sham group (2 of 50 [4%]) (P < .001). These effects persisted at follow-up. Transcranial direct current stimulation was well tolerated, and adverse effects did not differ between groups, except for burning sensation over the scalp in the active group (43.8%) vs the sham group (14.3%) (P = .003). Conclusions and Relevance: Transcranial direct current stimulation was effective and safe in ameliorating negative symptoms in patients with schizophrenia. Trial Registration: ClinicalTrials.gov identifier: NCT02535676.
Assuntos
Esquizofrenia/terapia , Estimulação Transcraniana por Corrente Contínua , Adulto , Antipsicóticos/uso terapêutico , Terapia Combinada , Método Duplo-Cego , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Psicologia do Esquizofrênico , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Estimulação Transcraniana por Corrente Contínua/métodos , Resultado do TratamentoRESUMO
Abstract Introduction: Random noise stimulation was reported as the more effective and safer type of electrical stimulation techniques in relieving tinnitus symptoms. The multisite protocol of transcranial random noise stimulation has shown additional favorable effects. Objective: Here we will discuss the role of applying eight sessions of multisite transcranial random noise stimulation in decreasing tinnitus loudness and annoyance without exerting additional adverse effects. Methods: Twenty-nine subjects (8 female), the mean age of (45.34 ± 9.57) with chronic tinnitus received transcranial random noise stimulation in the multisite protocol, 10 min of auditory-transcranial random noise stimulation applied over the T3, T4 preceded by 10 min of prefrontal-transcranial random noise stimulation applied over F4, FP1. In the first group, only one session was applied and the multiple-sessions group contained eight repeated sessions. Visual analog scale scores for loudness and distress were recorded before and immediately after the treatment. Multivariate repeated measure ANOVA test was used and minimal detectable change calculated. Results: There was a statistically and clinically significant reduction in tinnitus loudness and annoyance in both groups (p < 0.05, effect size (η 2) > 0.8), while the amount of annoyance suppression in the multiple-sessions group was significantly greater than the single-session group. The patients of the multiple-sessions transcranial random noise stimulation group reported an improvement in their sleep and lower tinnitus handicap inventory scores without experiencing any additional adverse effects of the intervention. Conclusions: The results of this study showed a substantial improvement in tinnitus symptoms by using the multiple sessions of transcranial random noise stimulation in the multisite protocol without producing any additional side effects. We suggest further clinical trials with long-term follow-up be investigated.
Resumo Introdução: Tem sido relatado que a estimulação transcraniana por ruído aleatório é um tipo mais eficaz e seguro de técnica de estimulação elétrica no alívio dos sintomas do zumbido. O protocolo multissítio da estimulação transcraniana por ruído aleatório mostrou efeitos favoráveis adicionais. Objetivo: Discutir o papel da aplicação de oito sessões de estimulação transcraniana por ruído aleatório multissítio na diminuição da intensidade (loudness) do som e incômodo (annoyance) do zumbido sem causar efeitos adversos adicionais. Método: Vinte e nove indivíduos com zumbido crônico (oito do sexo feminino), com média de 45,34 ± 9,57 anos, receberam estimulação transcraniana por ruído aleatório no protocolo multissítio, 10 minutos de estimulação transcraniana por ruído aleatório-auditivo aplicado no T3, T4 precedido por 10 min de estimulação transcraniana por ruído aleatório pré-frontal aplicado sobre F4, FP1. No primeiro grupo, apenas uma sessão foi aplicada e o grupo de múltiplas sessões recebeu oito sessões. Os escores da escala visual analógica para a intensidade do som (loudness) e incômodo (annoyance) do zumbido foram registrados antes e imediatamente após o tratamento. O teste Anova multivariada para medidas repetidas foi utilizado e a mudança mínima detectável foi calculada. Resultados: Houve uma redução estatisticamente e clinicamente significante na intensidade e incômodo do zumbido em ambos os grupos (p < 0,05; tamanho do efeito (η2) > 0,8), embora o nível de supressão do incômodo no grupo de sessões múltiplas tenha sido significantemente maior do que no grupo de sessão única. Os pacientes do grupo estimulação transcraniana por ruído aleatório com múltiplas sessões relataram uma melhoria no sono e menores escores no tinnitus handicap inventory, sem experimentar quaisquer efeitos adversos adicionais da intervenção. Conclusão: Os resultados deste estudo mostraram uma melhora substancial nos sintomas do zumbido utilizando múltiplas sessões de estimulação transcraniana por ruído aleatório no protocolo multissítio sem produzir quaisquer efeitos colaterais adicionais. Sugerimos que novos ensaios clínicos com seguimento de longo prazo sejam realizados.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Zumbido/terapia , Estimulação Transcraniana por Corrente Contínua/métodos , Análise de Variância , Estimulação Transcraniana por Corrente Contínua/efeitos adversosRESUMO
BACKGROUND: Cognitive deficits are core symptoms of schizophrenia that occur from the early stages of the disorder. There is reliable evidence that cognitive deficits are associated with outcomes in schizophrenia; thus, early treatment could be particularly important. Studies with different neuromodulation techniques involving subjects with schizophrenia suggest that application of transcranial direct current stimulation (tDCS) with inhibitory stimulation over the left temporo-parietal cortex and excitatory stimulation over the left dorsolateral prefrontal cortex could ameliorate positive, negative, and cognitive symptoms. The aim of the present study protocol is to evaluate the efficacy of tDCS in the treatment of cognitive symptomatology in the early stages of psychosis. METHODS/DESIGN: Seventy patients in the early stages of psychosis will be randomly allocated to receive 20 min of active 2-mA tDCS or sham stimulation once a day for 10 consecutive weekdays. The anode will be placed over the left dorsolateral prefrontal cortex and the cathode over the left temporo-parietal cortex. Neuropsychological and psychiatric assessments will be performed at baseline and at 1 and 3 months following the end of the intervention (sustained effect). DISCUSSION: The development and utilization of potentially effective neuroenhancement tools such as the non-invasive brain stimulation technique tDCS for the treatment and rehabilitation of cognitive impairment in the early stages of schizophrenia may contribute to improving outcomes of the disorder and eventually provide a further understanding of the nature of the complex and dynamic neural processes underlying those abnormalities. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03071484 . Registered on 7 March 2017.
Assuntos
Córtex Cerebral/fisiopatologia , Transtornos Cognitivos/terapia , Cognição , Esquizofrenia/terapia , Psicologia do Esquizofrênico , Estimulação Transcraniana por Corrente Contínua , Adolescente , Adulto , Brasil , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lobo Parietal/fisiopatologia , Córtex Pré-Frontal/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Esquizofrenia/diagnóstico , Esquizofrenia/fisiopatologia , Lobo Temporal/fisiopatologia , Fatores de Tempo , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Persistent pain can lead to incapacitation requiring long-term pharmacological treatment. Up to 82% of chronic kidney disease (CKD) patients undergoing hemodialysis (HD) have chronic pain and most do not respond to usual medication. Advances in non-pharmacological treatments are necessary to promote pain relief without side effects and to restore functionality. Transcranial direct current stimulation (tDCS) promises to be a novel, cost-efficient, non-pharmacological treatment for CKD patients with chronic pain. In this study, we hypothesize that tDCS could improve pain, depression, functionality, and quality of life in patients with CKD undergoing HD. METHODS/DESIGN: We describe a single-center, parallel-design, double blind randomized, sham-controlled trial. Forty-five subjects with CKD undergoing HD will be randomized to a motor cortex (M1), a dorso lateral prefrontal cortex (DLPFC), or a sham group. A total of ten sessions will be administered to participants over 4 weeks using a monophasic continuous current with an intensity of 2 mA for 20 min. Participants will be evaluated at baseline, immediately after the tenth session, and at 1 week and 4 weeks of follow-up after the intervention. Pain, depression, functionality, and quality of life will be evaluated. DISCUSSION: The results from this study will provide initial clinical evidence on the efficacy and safety of tDCS in patients with CKD undergoing HD. TRIAL REGISTRATION: Brazilian Clinical Trials Registry/Registro Brasileiro de Ensaios Clínicos (ensaiosclinicos.gov.br), 1111-1216-0137. Registered on 20 June 2018.
Assuntos
Afeto , Dor Crônica/terapia , Manejo da Dor/métodos , Qualidade de Vida , Diálise Renal , Estimulação Transcraniana por Corrente Contínua/métodos , Adolescente , Adulto , Idoso , Depressão/terapia , Método Duplo-Cego , Feminino , Seguimentos , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor , Medição da Dor , Córtex Pré-Frontal , Insuficiência Renal Crônica/terapia , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Adulto JovemRESUMO
INTRODUCTION: Random noise stimulation was reported as the more effective and safer type of electrical stimulation techniques in relieving tinnitus symptoms. The multisite protocol of transcranial random noise stimulation has shown additional favorable effects. OBJECTIVE: Here we will discuss the role of applying eight sessions of multisite transcranial random noise stimulation in decreasing tinnitus loudness and annoyance without exerting additional adverse effects. METHODS: Twenty-nine subjects (8 female), the mean age of (45.34±9.57) with chronic tinnitus received transcranial random noise stimulation in the multisite protocol, 10min of auditory-transcranial random noise stimulation applied over the T3, T4 preceded by 10min of prefrontal-transcranial random noise stimulation applied over F4, FP1. In the first group, only one session was applied and the multiple-sessions group contained eight repeated sessions. Visual analog scale scores for loudness and distress were recorded before and immediately after the treatment. Multivariate repeated measure ANOVA test was used and minimal detectable change calculated. RESULTS: There was a statistically and clinically significant reduction in tinnitus loudness and annoyance in both groups (p<0.05, effect size (η2)>0.8), while the amount of annoyance suppression in the multiple-sessions group was significantly greater than the single-session group. The patients of the multiple-sessions transcranial random noise stimulation group reported an improvement in their sleep and lower tinnitus handicap inventory scores without experiencing any additional adverse effects of the intervention. CONCLUSIONS: The results of this study showed a substantial improvement in tinnitus symptoms by using the multiple sessions of transcranial random noise stimulation in the multisite protocol without producing any additional side effects. We suggest further clinical trials with long-term follow-up be investigated.
Assuntos
Zumbido/terapia , Estimulação Transcraniana por Corrente Contínua/métodos , Adulto , Análise de Variância , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Transcraniana por Corrente Contínua/efeitos adversosRESUMO
Abstract Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that modulates cortical excitability. It is devoid of serious adverse events and exerts variable effects on cognition, with several research findings suggesting that it can improve memory, verbal and mathematical skills. Because tDCS devices are low-cost, portable and relatively easy to assemble, they have become available outside of the medical setting and used for non-medical ("cosmetic") purposes by laypersons. In this sense, tDCS has become a popular technique aiming to improve cognition and the achievement of a better performance not only at work, but also in other fields such as sports, leisure activities (video games) and even the military. In spite of these unforeseen developments, there has been a general paralysis of the medical and regulatory agencies to develop guidelines for the use of tDCS for cosmetic purposes. Several challenges are present, most importantly, how to restrict tDCS use outside of the medical setting in face of variable and sometimes conflicting results from scientific research. This article aims to describe the popular use of tDCS, in light of the pillars of neuroethics, a branch of bioethics relative to brain research. Between two possible but extreme solutions - total release or total restriction of tDCS - it is paramount to develop a spectrum of alternatives, which may vary over time and in different cultural backgrounds.
Resumo A estimulação transcraniana por corrente contínua (ETCC) é uma técnica não invasiva de estimulação cerebral que modula a excitabilidade cortical. A ETCC é desprovida de efeitos adversos graves e exerce efeitos variáveis sobre a cognição, com vários achados de pesquisa sugerindo que a técnica pode promover melhora nas habilidades mnêmica, verbal e matemática. Devido ao seu baixo custo, portabilidade e facilidade de montagem, os aparelhos de ETCC tornaram-se disponíveis fora do contexto médico, sendo usados para fins não médicos ("cosméticos") por indivíduos leigos. Nesse sentido, a ETCC tornou-se um procedimento popular para aprimoramento da cognição e a realização de melhor desempenho não somente no ambiente de trabalho, mas também em campos tais como o esporte, atividades de lazer ( video games ) e até no meio militar. Apesar desses acontecimentos imprevisíveis, há uma certa morosidade das agências médicas e regulatórias em desenvolver diretrizes para o uso de ETCC para fins cosméticos. Há muitos desafios presentes, principalmente, como restringir o uso da ETCC fora do contexto médico em face de resultados variáveis, e muitas vezes conflitantes, da pesquisa científica sobre o tema. Este artigo tem como objetivo descrever o uso popular da ETCC sob a luz da neuroética, um ramo da bioética que se dedica ao estudo do cérebro. Entre duas situações possíveis, mas extremas - liberação ou restrição totais da ETCC -, é primordial o desenvolvimento de um espectro de alternativas, que podem variar ao longo do tempo e depender de diversos contextos culturais.
Assuntos
Humanos , Encéfalo/fisiologia , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Estimulação Transcraniana por Corrente Contínua/instrumentação , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Transcraniana por Corrente Contínua/ética , Processos Mentais/fisiologiaRESUMO
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that modulates cortical excitability. It is devoid of serious adverse events and exerts variable effects on cognition, with several research findings suggesting that it can improve memory, verbal and mathematical skills. Because tDCS devices are low-cost, portable and relatively easy to assemble, they have become available outside of the medical setting and used for non-medical ("cosmetic") purposes by laypersons. In this sense, tDCS has become a popular technique aiming to improve cognition and the achievement of a better performance not only at work, but also in other fields such as sports, leisure activities (video games) and even the military. In spite of these unforeseen developments, there has been a general paralysis of the medical and regulatory agencies to develop guidelines for the use of tDCS for cosmetic purposes. Several challenges are present, most importantly, how to restrict tDCS use outside of the medical setting in face of variable and sometimes conflicting results from scientific research. This article aims to describe the popular use of tDCS, in light of the pillars of neuroethics, a branch of bioethics relative to brain research. Between two possible but extreme solutions - total release or total restriction of tDCS - it is paramount to develop a spectrum of alternatives, which may vary over time and in different cultural backgrounds.