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Explore the evolution of Transcranial Electrical Stimulation (tDCS) from the 18th century to modern applications, understanding its physiological effects and practical implications. Discover the mechanisms of action, pharmacological perspectives, safety measures, and recent innovations in tACS and tRNS. Stay informed about the latest developments in this field.
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Transcranial electrical stimulation - tDCS and friends MA Nitsche Georg-August-University, Dept. Clinical Neurophysiology, Goettingen, Germany
Common aspects of thesetreatments • Suprathreshold stimulation • Phenomenological effects DCS • Subthreshold stimulation • Physiological effects
Principal action of DC-stimulation: modulation of resting membrane potential
Cortical DC-stimulation of the rat: effects during stimulation … Baseline Text Text Text Text cathodal anodal Bindman et al. 1964
…and after-effects anodal cathodal Bindman et al. 1964
After-effects are protein synthesis-dependent Gartside 1968
…and accompanied by specific biochemical alterations 30 min 3 h stimulation dark neurones
50% of transcranially applied direct currents reach the brain - calculations on realistic head models, validation in animal experiments (Rush & Driscoll 1968) - validation in humans (Dymond et al. 1975)
Polarity-dependent excitability-modulation during tDCS Nitsche & Paulus 2000
Enhanced motor cortico-spinal excitability after anodal stimulation Nitsche & Paulus 2001
Reduced motor cortico-spinal excitability after cathodaltDCS 1.2 1.0 0.8 0.6 0.4 1 5 10 15 20 25 30 35 40 45 50 55 60 90 120 min Nitsche et al. 2003
DC electrode Intracortical afferents Pt-neuron Mechanisms of action - the electrophysiological perspective
70 60 Intra-tDCS 50 40 30 DC electrode 20 10 0 Intracortical afferents Pt-neuron Cortico-spinal effects I-O curve Resting motor threshold Active motor threshold 1 mA, 35 cm2 non (a) non (c) anodal cathodal Nitsche et al. 2005
DC electrode Intracortical afferents Pt-neuron Pt-neuron effects TMS TES cathodal anodal 1 mA, 35 cm2 1,5 mA, 35 cm2 Nitsche & Paulus 2000, 2001, Nitsche et al. 2003 Ardolino et al. 2005
DC electrode Intracortical afferents Pt-neuron intracortical effects intracortical facilitation/inhibition cathodal anodal 1 mA, 35 cm2 I-wave facilitation cathodal anodal 1 mA, 35 cm2 Nitsche et al. 2005
DC electrode DC electrode Intracortical afferents Intracortical afferents Pt-neuron Pt-neuron Differentiation between intracortical/corticospinal effects Boros et al. 2008
Conclusion I Cortico-spinal effects SP-MEP, I-O curve, (threshold) Intracortical effects SICI, ICF, (I-waves) Pt neurons (TES) ?????
Na, Ca Mechanisms of action - pharmacological perspective Na, Ca NMDA Transmitter Na, Ca GABA Na, Ca DA Na, Ca ACh Mdodulator Na, Ca Serotonine
Acute effects of tDCS are ion channel-dependent Drug and stimulation condition Nitsche et al. 2003, 2004
Pharmacological dependance of after-effects of tDCS I Nitsche et al. 2003
Pharmacological dependance of after-effects of tDCS II Nitsche et al. 2003, 2004
Pharmacological modulation of after-effects I Nitsche et al. 2006, Kuo et al. 2008
Pharmacological modulation of after-effects II Kuo et al. 2008, 2007, Nitsche et al., 2009
Conclusion II Na, Ca Ca NMDA Ca GLU AMPA AMPA GABA DA ACh Serotonine ???????
Focality of tDCS Imaging Functional M1 premotor Baudewig et al. 2001, Lang et al. 2005 Nitsche et al. 2005
Increasing the focality of tDCS by reducing the size of the stimulation electrode I Nitsche et al. 2007
Increasing the focality of tDCS by reducing the size of the stimulation electrode II
Increasing the focality of tDCS by increasing the size of the reference electrode
Safety of tDCS • No enhancement of NSE (Nitsche & Paulus 2001, Nitsche et al. 2003 • No cerebral edemas or related alterations (Nitsche et al. 2004) • No epileptic seizures (Liebetanz et al. 2006) • Current protocols well below the threshold of tissue damage (Liebetanz et al. 2009)
Recent developments tACS tRNS
tACS Relatively small effects on motor cortex excitability... Antal et al. 2008
...but prominent functional effects Antal et al. 2008, Kanai et al. 2008
tRNS Motor cortex excitability Motor learning Terney et al. 2008