Although the home use of tDCS is often referred to as a novel phenomenon, in reality the late nineteenth and early twentieth century saw a proliferation of electrical stimulation devices for home use.
In particular, the use of a portable electrotherapy device known as the “medical battery” bears a number of striking similarities to the modern-day use of tDCS.
Many features related to the home use tDCS—a do-it-yourself movement, anti-medical establishment themes, conflicts between lay and professional usage—are a repetition of themes that occurred a century ago with regard to the medical battery.
A number of features seem to be unique to the present, such as the dominant discourse about risk and safety, the division between cranial and non-cranial stimulation, and utilization for cognitive enhancement purposes.
Viewed in historical context, the contemporary use of electrical stimulation at home is not unusual, but rather the latest wave in a series of ongoing attempts by lay individuals to utilize electricity for therapeutic purposes.
Borrowed (screen shot) from the July 2014 Roi Cohen Kadosh edited ‘The Stimulated Brain’ (Google Books link which, though many pages missing, is still full of excellent info or buy it on Amazon,affiliate link).
Click image to open in full size.
An intelligent introduction to tDCS and TMS in the context of Cognitive Enhancement. Dr. Roy Hamilton (at around 19:00 in the video, the beginning is basic intro boilerplate) discusses studies which demonstrate significant positive cognitive effects in healthy individuals. I especially liked Dr. Hamilton’s take on the concerns and potential risks of non-invasive brain stimulation which he discusses towards the end of his talk.
Michael Weisend PHD. is a principal investigator at The Mind Research Network, MRN.org, and assistant professor of Translational Neuroscience at the University of New Mexico, Albuquerque. Dr. Weisend and his team pioneered a method for determining optimal brain regions for tDCS stimulation using fMRI. Much of Dr. Weisend’s work is focused on cognitive enhancement in healthy subjects for the purpose of reducing the amount of time it takes to master a skill. He shared a full hour of his time and a wealth of tDCS-related information. Download the interviewhere (zipped mp3). Subscribe in iTunes. (Firefox users- there’s an issue with the html5 audio player. In the meantime you can download the episode or open the page in another browser).
Just found this in iTunesU. Wow! You’ll recognize many of these names if you’re reading the tDCS literature. I’ve only watched the Michael Weisend talks (whom we met earlier on the blog) so far. I have a much better understanding of the difficulty of running a tDCS trial now. There’s a lot that can go wrong. If your protocols aren’t set up just right, your information might be useless. Here’s the web link iTunes Link from which you can download in iTunes. Downloads are quite slow.
Introduction to Neurosystems Engineering, Spring 2011 (ECE 595) Neurosystems Engineering is an emerging field at the intersection of Neuroscience, Psychology, and Engineering, and the University of New Mexico is its epicenter.
Course Intro Dr. Gerold Yonas
Course Syllabus Dr. Gerold Yonas
Tools and Techniques in Neuronal Stimulation Dr. Edl Schamiloglu
Basic Principles of Feedback and Control Prof. Chaouki T. Abdallah
Discussing the Course General Approach and Direction Dr. Gerold Yonas
Effects of Direct Current, Non-Invasive Brain Stimulation on Learning Michael Weisend
In the Laboratory Transcranial Direct Current Stimulation (tDCS) Michael Weisend
Posttraumatic Stress Disorder: Roles for Treatment & Prevention (Part I) Dr. Pilar M Sanjuan
Posttraumatic Stress Disorder Roles for Treatment & Prevention (Part II) Dr. Pilar M Sanjuan
Tour of the Mind Research Network Dr. Vince D. Calhoun
Neuroimaging of Intelligence and Creativity (Part I) Dr. Rex E. Jung
Neuroimaging of Intelligence and Creativity (Part II) Dr. Rex E. Jung
Memories and Migraines: Application of tDCS Laura Matzen
Neurochemistry Application in NonInvasive Brain Stimulation Dr. Charles Gasparovic
Non-Invasive Brain Stimulation 1:03:47 Lucas C. Parra
Epilepsy, Autism, and Novel Treatment Strategies Dr. Jeffrey David Lewine
The Emerging Field of Sleep Disorders Medicine Dr. Barry Krakow
Presentation of Class Projects Student
Marom Bikson is CEO of Soterix Medical and Associate Professor at City College of New York in the Department of Biomedical Engineering. Marom is a distinguished tDCS scientist and prominent in the development of HD-tDCS. Download the interviewhere (zipped mp3). (Firefox users- there is an audio player here, but it’s displaying intermittently. Trying to track down the issue. In the meantime you can download the episode or open the page in another browser).
(We got a good forty minutes of interview in before the Skype gremlins caught up with us. I had to cobble an ending together.)
Perhaps depression studies are closest to FDA qualification for tDCS?
(Prediction is very hard, especially about the future – Yogi Berra.)
A device (NorDoc Smartstim) that can go to 4mA is being used in a smoking cessation trial? (Trial info indicates 2mA current dose.)
FDA tDCS approval would be device-specific at first. But would open the door to ‘me too’ mechanism, FDA 510(k)
HD tDCS can have multiple cathodes and or multiple anodes. An array of 4 small anodes splitting 2mA, for example (.5 mA each electrode), can function as an anodal ‘virtual pad’. Assumes cathode somewhere else on the body).
Image By Richard McKinley USAF
Tolerability is how tolerable in terms of side effects a medication is.
A Theory of tDCS (“Gross oversimplification”) As positive current flows into the cortex it passes neurons.
Because of the nature of neurons, this positive current depolarizes somas (cell’s body), increasing excitability, thereby increasing the functionality & plasticity of that region (hypothesis… “We really don’t know.”). Under the cathode, somas (cells) are being hyper-polarized – excitabilty decreases.
A synapse is a structure that permits a neuron (or nerve cell) to pass an electrical or chemical signal to another cell. Pyramidal neuron
Titration, also known as titrimetry, is a common laboratory method of quantitative chemical analysis that is used to determine the unknown concentration of an identified analyte.
TES Transcranial Electric Stimulation
“transcranial electrical stimulation” Merton and Morton 1980
“Priming the network in conjunction with applying tDCS makes a lot of sense, as a way to make the tDCS to do what you want.” (Co-priming – The idea that one would initiate an activity first, and THEN add tDCS.)
[Apologies for audio quality. It won’t happen again.]
Dr. Jim Fugedy runs the Brain Stimulation Clinic, in Atlanta, GA, and has been treating patients using tDCS since 2007. Download the interviewhere (zipped mp3).
Dr. Jim Fugedy
The Brain Stimulation Clinic in Atlanta is the destination for memory and learning enhancement and treatment-resistant patients who suffer from chronic pain, fibromyalgia, migraine headaches, CRPS, depression and tinnitus. Transcranial direct current stimulation (tDCS) therapy is provided in a pleasant, relaxing environment. Instruction, training and supervision for home use is also available for select patients.
Jim is an anesthesiologist.
The study Jim refers to regarding Felipe Fregni & fibromyalgia: A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia (full pdf)
tDCS for treatment of fibromyalgia is not certified – it’s ‘off label’
Device is certified, but not for tDCS = no insurance code, can’t be billed to insurance
20 minute treatment for 5 days.
For fibromyalgia – reduces pain, improves issues – fatigue, compromised mental function
(ActivaDose ii Update 3/16 now available as complete tDCS kit through Caputron Medical, use voucher code ‘diytdcs’ for generous discount.)
Most benefit… chronic depression, treatment protocol based on Colleen Loo, Black Dog Institute 6 weeks, follow up maintenance. Up to 8 weeks of treatment + 1-2 treatments follow up maintenance. Daily 20 minute sessions
Can be treated at the clinic for 1-2 weeks. Or home treatment package.
“To treat depression, I place the anode over the left dlpfc (left dorsolateral prefrontal cortex) and the cathode over the contralateral supraorbital area. I have tried positioning the cathode over the contralateral dlpfc and extracephalically (opposite shoulder or upper arm), but the contralateral supraorbital locations provides the most robust effect.” (Correspondence)
Pain montage 2mA, anode M1 & cathode contralateral supra-orbital area
For chronic pain, the M1 is the most used area and that’s almost always my first choice. But you can use the cathode over the somatosensory (S1) cortex, to down-regulate the patient’s perception of pain.
And you can also stimulate the Dorsalateral prefrontal cortex which is involved in the emotional component of pain.
Looking at stimulating right dorsalateral prefrontal cortex to attenuate anxiety.
… it may be a location
for the non-pharmaceutical treatment for ADD.
Office visit $150.
Home use treatment package $2400 includes in-office evaluation and training, ActivaDose ii device, electrodes, and unlimited follow-up via visit, phone, skype…
Only side effect Jim has seen is skin burn (but easily avoided with sponge electrodes).
(Patient with skin burns who’d been treated by a doctor using electroencephalogram (EEG) electrodes.)
Tinnitus responds well, though temporarily, to tDCS
Anode, right dorsalateral prefrontal cortex, cortex opposite supra-orbital Harvard one day course on how to treat with tDCS. Taught 3-4 times a year.
Contrast with approved Electromagnetic treatment for depression (I think he’s referring to TMS transcranial magnetic stimulation here) A 6 week 30 treatment protocol costs between $10-15,000. Affects last about 6 months. And even though it’s certified, it’s not covered by insurance.
…”in the 12 years that it’s been used there have been no side effects reported other than skin (irritations).
“You know we hear stories about Canadians having to wait for surgery. But in the United States, if you don’t have the money and you don’t have insurance, you don’t have to worry about waiting, you won’t get the surgery.”
You can reach Jim at: doctorfugedy [theAtSignHere] transcranialbrainstimulation.com
Well here we go! Episode one of the DIY tDCS podcast. Ana Maiques is co-founder (with Giulio Ruffini) of Spanish-based Starlab. Their spin-off company, Neuroelectrics makes Enobio, a research-quality wireless EEG device, and Starstim, a multi-channel wireless tcs & tDCS device. Download the interviewhere (zipped mp3). Show notes after the fold.
Ana Maiques of Starlab and Enobio
Ana Maiques wearing her Enobio
(If you speak Spanish you might enjoy the interview these photos were taken from.) Also, if you’re an EEG or tDCS researcher or clinician (or VC) on the East Coast, Ana is frequently in the New York and Boston area and is happy to discuss Enobio and Starstim. Neuroelectrics will be at the Advances in Mediation Research conference in NY Jan. 17 2013. (Schedule) Check out the Neuroelectrics blog for excellent tDCS and EEG info.
Starlab is the parent company > Space (sensors) + Neuroscience
Cutting edge research > impact on society… products and services
Twelve years of research in neuroscience > Enobio, Starstim
Initial market is early adopters – researchers, clinicians and practitioners
Starstim (tDCS) > chronic pain, stroke rehabilitation (later… depression >> cognitive enhancement, addiction)
Medically certified in Europe and Canada
Filing 510k for Enobio in the US
Starstim has 8 channels for use as HD tDCS but can also use traditionally
Can also do tACS (alternating current), or random noise stimulation and at the same time Simultaneously record EEG
Can also use dry EEG electrodes Roi Cohen Kadosh Oxford study, kids etc. (Link to video we discussed. NewScientist)
Study will determine if tDCS is efficacious in enhancing performance in certain areas (math)
Will have implications for people with Alzheimers
Partnerships with 15 hospitals doing research with Starstim
8 in U.S. and 7 in Europe. Different pathologies. Results to be published soon.
Post-stroke rehabilitation is a great place to see the effectiveness of tDCS
tDCS > Motor recovery… hand rehabilitation…
Can thereby measure the degrees of movement and improvement very objectively
Couple of groups showing very measurable results.
The Muse, Neurosky, Emotiv Home EEG devices?
Limitation is number of channels.
Started Enobio with 4 channels, but feedback from medical community lead to developing a 20 channel Enobio.
For certain applications – games, BCI etc, the home EEG devices might be fine
But we’re looking at the medical application of EEG.
Doctors and researchers require the maximum coverage of the head.
Signal quality is very important.
Emotion recognition, neural marketing, traumatic brain injury – concussion
BCI – wheelchairs.
Sponsoring a conference in NY on meditation. Sloan Kettering pre-chemo
medications >> less pain, better toleration of treatment.
Spanish VCs even more conservative since crisis
Patents >> cloud-based database recording experimental data
Software runs on a Mac.
“We always said we want to be the Apple of neuroscience…”
Every military application of tDCS I’ve seen so far specifically mentions drones and drone pilot training. This logo has a drone in it! For the record, I think the use of drones is illegal and immoral, and that the deaths of innocents is un-American and unacceptable. That said, the tDCS research coming out of this sector is fascinating and will no doubt have an impact beyond military training.
This comes to us via the Neuroelectrics.com blog. I’m very excited to see Neuroelectrics on the scene. I first noticed their device Starstim (pictured), popping up in news around Roi Cohen Kadish’s ongoing tDCS trials at his Oxford lab (see). I believe Neuroelectrics is a Spanish company. What’s especially exciting to me is that they also make an EEG device called Enobio and are working on the ability to map brain activity with EEG while undergoing tDCS. Think about that! Live, in-the-moment feedback on exactly what effect your tDCS is having.
More than 100 studies have been performed using tDCS in healthy controls and in patient populations, and no serious side effects have occurred for a review, see Nitsche and others 2008. Slight itching under the electrode, headache, fatigue, and nausea have been described in a minority of cases in a series of more than 550 subjects Poreisz and others 2007. Detailed studies have been performed to assess the safety of tDCS. These have shown that there was no evidence of neuronal damage as assessed by serum neuron-specific enolase after application of a 1 mA anodal current for 13 minutes Nitsche and Paulus 2001; Nitsche, Nitsche, and others 2003 or MRI measures of edema using contrast-enhanced and diffusion-weighted MRI measures after application of a 1 mA current for 13 minutes anodal or 9 minutes cathodal; Nitsche, Niehaus, and others 2004 […] In addition, a recent study was performed in rats using an epicranial electrode montage designed to be similar to that used in tDCS Liebetanz and others 2009. This demonstrated that brain lesions occurred only at current densities greater than 1429 mA/cm2 applied for durations longer than 10 minutes. In standard tDCS protocols in humans, a current density of approximately 0.05 mA/cm2 is produced.
[Update 10/19] Dr. Clark’s TEDxUNM just in. tDCS starts around 6:45
Dr. Clark is a pioneer of tDCS research. He recently spoke at TEDxUNM (TED talk at the University of New Mexico). I’m eagerly awaiting a video of his talk and will post it as soon as it becomes available. In the intro to Dr. Clark’s talk I found this amazing story.
You really need to read the full story. It outlines Dr. Clark’s journey to diagnose a rare disease that affected his 9 year old boy. tDCS is one of 3 treatment modalities he discussed in his talk…
Clark is already using tDCS to help treat drug addicts and reduce symptoms in people with Parkinson’s disease. As a part of this research, Clark is examining the ability to use tDCS to treat chronic pain, which he learned about while trying to find ways to reduce the amount of pain Ryan suffered. He’s been collaborating with other research groups that are having success using this procedure to reduce pain.
“It might be the first time that someone has come up with a way to treat pain consistently, but without using a drug,” he added.
Update 10/1/12 Dr. Clark is involved in a new site which “is meant to offer information and links about medical alternatives that are cheaper, safer and more effective than the current standard of care.” SmallerMedicine.com (links to tDCS page).