Self-Administered Domiciliary tDCS Treatment for Tinnitus | Sooma Medical

Unfortunately the study found little to no benefit (no more than sham) using tDCS with two different montages to treat tinnitus. What is very interesting however, is that the study allowed participants to administer tDCS at home.

A Sooma tDCSTM device (Sooma Oy, Helsinki, Finland) was used in the study. The device is designed and approved for patient use with pre-programmed treatment parameters and hardware-level safety limits. Patients were given a package consisting of the stimulator unit and stimulation electrodes (consisting leads and pads) along with three pairs of sponge pouches for the electrode pads, a head cap with openings for the electrodes (Fig 1), a chinstrap and 0.9% saline solution.

tdcsElectrodePouchCap

In Europe, Sooma depression solution was approved for depression treatment in 2014.

tdcsSoomaMedical2

Download the Sooma brochure (pdf)

tdcsSoomaMedical

 

tDCS Depression Montage

Marom Bikson (no less!) demonstrating depression montage using the Soterix EasyStrap.

From a recent Marom Bikson slide deck.

From a recent Marom Bikson slide deck (pdf).

Low Field Magnetic Stimulation

All roads LFMS lead to the Harvard Low Field Magnetic Stimulation Lab. But please follow along with what led me here in the story below.

Harvard's Low Field Magnetic Stimulation Lab

Harvard’s Low Field Magnetic Stimulation Lab

I came across Low Field Magnetic Stimulation, or LFMS, in a recent panel talk from SXSW: Superbugs, Magnets & More: Medicine’s Comeback Kids – SXSW Interactive 2015. The conversation is particularly interesting considering panelist Dr. Bennett Shapiro’s background. At Merck he led research that developed over 25 drugs and vaccines. (The panel touches on magnets, phage therapy and fecal transplants, for example.)

Dr. Shapiro’s company (he is the co-founder and non-executive director), Pure Tech Health created Tal Medical, to develop an LFMS treatment/device.
This is most likely the nexus for looking into LFMS in the first place:

Anecdotal reports have suggested mood improvement in patients with bipolar disorder immediately after they underwent an echo-planar magnetic resonance spectroscopic imaging (EP-MRSI)… Low-Field Magnetic Stimulation in Bipolar Depression Using an MRI-Based Stimulator  (Found on the Tal Medical publications page.)

The panel discusses TMS, which has recently been approved by the FDA for treatment of depression. But Dr. Shapiro goes on to discuss LFMS, which (to my readers anyway) is especially interesting because it uses so little power to achieve its effects. (As opposed to TMS which is too complicated and powerful to ever become part of the DIY community. Never say never!)

In 2013, Tal received initial proof-of-concept data from a randomized, double-blind, sham-controlled trial in patients with major depressive and bipolar disorders conducted by McLean Hospital, a leading psychiatric research hospital affiliated with Harvard Medical School. In the study, a single 20-minute treatment demonstrated rapid onset of action, substantial effect size, and a strong safety profile. Given this unique, rapid effect of LFMS treatment, the National Institute of Mental Health has selected LFMS for a multi-site clinical trial. The trial is examining the efficacy and durability of the treatment over an extended period of time in patients with major depressive disorder.

Researching possible patents led to Michael Rohan, Ph.D. and the Harvard Low Field Magnetic Stimulation Lab. I assume there is a partnership between the Harvard Lab, McLean Hospital and Tal Medical, though I could not find any formal announcement. Click through the lab link to do a deeper dive into ongoing research they are presently involved with, including clinical trials.

Canadian study tests electrical stimulation to treat depression in pregnancy | CTV News

Update 12/16/2015: Bouncing this story up to the top again today because of news of a new study that links Autism to SSRI (anti-depressant) use in pregnant women.

The analysis also found that women who were prescribed more than one class of antidepressants during the last six months of pregnancy were more than four times more likely to have a child with autism, compared with women who did not take antidepressants while pregnant.

Update 10/16/2015: Today I learned that this study is ongoing and recruiting participants. If you or someone you know is pregnant and dealing with severe depression, consider contacting study author Simone Vigod at Women’s College Hospital in Toronto. Study Protocol. You can also follow Simone on Twitter.

Watch the video at CTV.
tdcsPregnantCTV

Tatania Samburova, a Russia-born economist who immigrated to Canada two years ago, developed depression before becoming pregnant. Her depression left her feeling hollow, even suicidal.

“You do not feel yourself living. You do not want anything, you do not want to go somewhere, to do something,” she said.

Her doctor offered her antidepressants, but, while she knew they would offer her relief, she decided against using them over fears they may harm her child.

“Even if it will bring me, right now, some kind of relief, it can also affect the life of a little child,” she said.

Instead, she travelled to Mount Sinai (hospital) every day for three weeks to be treated as part of the study. She doesn’t know for sure if she received a sham treatment or the actual tDCT stimulation but suspects she had the actual therapy because within days her appetite returned and she felt her mood lifting.

“This treatment brought happiness back to me; it brought life back to me,” she said.

She remains well today, with her baby due mid-March.

Vigod notes that some women are so desperate for treatment that they are not waiting for the study results.

“I can tell you anecdotally that women are buying devices like this in the U.S. and using them at home, but they haven’t really been tested to see if it works to make the depression better.”

via Canadian study tests electrical stimulation to treat depression in pregnancy | CTV News. HDCstim (device shown)

tdcsPregnantDepressionStudy

From the study protocol: The active tDCS intervention is active 2 mA tDCS. Direct current is transferred continuously for 30 minutes with a pair of saline-soaked sponge electrodes (contact area of 5 × 7 cm), and delivered by a specially developed, battery-driven constant current stimulator. The electrodes are placed over F3 and F4 according to the 10–20 international system for electroencephalogram placement.

Hooking up: zapping your brain

Katie, 23, has suffered from anxiety and depression since she was 18. When her boyfriend Lee told her about transcranial directcurrent stimulation (tDCS), a form of neurostimulation which involves administering a low level of electrical current to the brain, she was sceptical. But Lee had heard that it could help people with mood disorders and wondered if she might benefit from it.

“The first time, I freaked out,” she remembers. “I thought, ‘I can’t cope with putting electrical stimulations in my brain.’ Lee put this machine on and, it’s difficult to explain, but, everything went empty in a good way. I can’t remember if I’ve ever felt like that. I felt relaxed and chilled inside. It was a mad sensation and an out-of-body experience.”

She’d tried anti-depressants in the past but found they didn’t work for her. Now she uses the kit regularly. “It’s improved my life and improved my mind,” she says.

Source: Hooking up: zapping your brain

Adventures in Transcranial Direct-Current Stimulation | The New Yorker

Adventures in Transcranial Direct-Current Stimulation author Elif BatumanElifBatuman
Excellent! We met Jim Fugedy in podcast episode #2

It is the rare human who doesn’t wish to change something about his or her brain. In my case, it’s depression, which runs on both sides of my family. I’ve been taking antidepressants for almost twenty years, and they help a lot. But every couple of years the effects wear off, and I have to either up the dose or switch to a different drug—neither process can be repeated indefinitely without the risk of liver or kidney damage. So although my symptoms are under control for now, I worry, depressively, about what will happen when I exhaust the meds. As I was researching this piece, my attention was caught by a number of randomized controlled trials showing a benefit from tDCS for depression. (The data are insufficient to allow definitive conclusions, but larger trials are in progress.) I was almost embarrassed by how excited I felt. What if it was possible to feel less sad—to escape the deterministic cycle of sadness? What if you could do the treatment yourself, at home, without the humiliation and expense of doctors’ visits? I asked Vince Clark whether any private physicians use tDCS outside of a research setting.

via Adventures in Transcranial Direct-Current Stimulation – The New Yorker.

Taming the black dog—new approaches to depression – All In The Mind – (Australian Broadcasting Corporation)

Or download audio:
http://mpegmedia.abc.net.au/rn/podcast/2014/12/aim_20141207.mp3

Lynne Malcolm: Colleen Loo says that this transcranial direct current stimulation treatment is best used for people with clinical depression who haven’t responded to other treatments. There are very few, if any, side-effects and some participants have even noticed benefits beyond changing their moods.

Colleen Loo: Yes, and this was very exciting. So when we did our first depression trial we were measuring things like memory and thinking…you know, it was just to be safe, to check these things. And one of the things we measured was we asked people to do a test which really showed you how quickly the brain was working. And as people went through the trial they were saying things like, ‘Gee, I don’t know what kind of stimulation I’m having, but it’s almost like my brain clears and I can concentrate and think so much more clearly after the stimulation.’

So we were very excited when we got the end of the study and we formally analysed the results of the formal test, that it showed exactly what people were saying to us, that after the act of stimulation the actual thinking speed was faster, and that has led our team to develop a whole parallel line of research of using TDCS to improve memory and thinking. So our main line of research is in treating depression, but I also have a very promising young researcher who is a clinical neuropsychologist, Dr Donel Martin, who is heading a whole program of research into using this to improve memory and thinking. For example, in people who are older and who are just starting to notice some changes in their memory and thinking.

via Taming the black dog—new approaches to depression – All In The Mind – ABC Radio National (Australian Broadcasting Corporation).

At-home brain stimulation gaining followers | Science News

Depending on where he puts the electrodes, Whitmore says, he has expanded his memory, improved his math skills and solved previously intractable problems. The 22-year-old, a researcher in a National Institute on Aging neuroscience lab in Baltimore, writes computer programs in his spare time. When he attaches an electrode to a spot on his forehead, his brain goes into a “flow state,” he says, where tricky coding solutions appear effortlessly. “It’s like the computer is programming itself.”
Whitmore no longer asks a friend to keep him company while he plugs in, but he is far from alone. The movement to use electricity to change the brain, while still relatively fringe, appears to be growing, as evidenced by a steady increase in active participants in an online brain-hacking message board that Whitmore moderates. This do-it-yourself community, some of whom make their own devices, includes people who want to get better test scores or crush the competition in video games as well as people struggling with depression and chronic pain, Whitmore says.

via At-home brain stimulation gaining followers | Science News.

Contributor Q&A: Cara Santa Maria gets her brain stimulated | Al Jazeera America

tDCS has so many promising applications – what excites you the most?

I’m personally most excited about the promise tDCS seems to hold for individuals with Major Depressive Disorder. Although the paradigm may be more complicated (what exactly is a behavioral treatment for depression?), if it has even a minor effect, it could help millions of people.

I have dealt with depression since I was a child. I see a therapist weekly and take a daily dose of citalopram, a selective serotonin reuptake inhibitor. I’m lucky that I’ve found a drug that works for me. Many people are not. They struggle to find an appropriate dose or maintain a drug after its effects change with time. If this proves to be a reliable alternative treatment, it could be a real game-changer.

via Contributor Q&A: Cara Santa Maria gets her brain stimulated | Al Jazeera America.

Would TDCS make me smarter? – Mary H K Choi – Aeon

One of the first things I notice about TDCS is that it’s like being able to set an appointment for a power nap. Time goes by at an unbelievable clip. Twenty minutes is a long time just to sit near someone blinking at you, so Fugedy leaves the room. He gives me a big gold Salvation Army bell so I can alert him when the 20 minutes are up. When he comes back into the room, I think he must have forgotten something. It feels like only five minutes, but it turns out 19 have already passed. I’m even slightly annoyed, as if I’ve been interrupted.

TDCS sort of feels like you’re about to fall asleep while knowing that you won’t completely conk out. My breathing slowed way down, and I started to feel cold. I was so relaxed, I couldn’t imagine having to shoot a gun like Sally Adee. I don’t know what ‘flow’ feels like but my thoughts became jumbled. I often daisy-chain absurd thoughts to entertain myself as I drift into sleep but this was different. I felt like I had no control over the remote.

via Would TDCS make me smarter? – Mary H K Choi – Aeon.
With the most valuable bit of info in the comments from Mrd about the montage he uses for his bipolar disorder…

What I currently do which involves suppressing the area between p4 and t4 while activating the left motor cortex or Wernickes area which means the current goes across from one side of the brain to the other has worked very well. I compliment this with using the typical montage for depression on alternate days.. I have found that I no longer need to do these as much probably due to neuroplasticity.

Catching Up – Articles of Note January 2013

Neurobiological Effects of Transcranial Direct Current Stimulation: A Review
The purpose of this systematic review is to summarize the current knowledge regarding the neurobiological mechanisms involved in the effects of tDCS.

Neuroenhancement of the aging brain: restoring skill acquisition in old subjects.
The main finding was that old participants experienced substantial improvements when training was applied concurrent with tDCS, with effects lasting for at least 24 hours.

Examining transcranial direct-current stimulation (tDCS) as a treatment for hallucinations in schizophrenia.
Auditory verbal hallucinations were robustly reduced by tDCS relative to sham stimulation…

Modulation of training by single-session transcranial direct current stimulation to the intact motor cortex enhances motor skill acquisition of the paretic hand.
tDCS facilitated the acquisition of a new motor skill compared with sham stimulation…

Interactions between transcranial direct current stimulation (tDCS) and pharmacological interventions in the Major Depressive Episode: Findings from a naturalistic study.
tDCS over the DLPFC acutely improved depressive symptoms…

Amelioration of cognitive control in depression by transcranial direct current stimulation.
Deficient cognitive control over emotional distraction is a central characteristic of major depressive disorder (MDD)
The present study demonstrates that anodal tDCS applied to the left dlPFC improves deficient cognitive control in MDD.

Transcranial direct current stimulation of the motor cortex in the treatment of chronic nonspecific low back pain: a randomized, double-blind exploratory study.
No significant effect was seen in the primary outcomes between active and sham stimulation

Comparing immediate transient tinnitus suppression using tACS and tDCS: a placebo-controlled study.
…bifrontal tDCS modulates tinnitus annoyance and tinnitus loudness, whereas individual alpha-modulated tACS does not yield a similar result.

Review of transcranial direct current stimulation in poststroke recovery.
In this review, we summarize characteristics of tDCS (method of stimulation, safety profile, and mechanism) and its application in the treatment of various stroke-related deficits, and we highlight future directions for tDCS in this capacity.

 

February 2013 tDCS Papers of Interest

If there’s no link to a pdf, it means the full paper is behind a paywall. If you find a public link to the full paper, please send it along and I’ll update the post. Did I miss anything 😉
Bold: Paper title, linked to Abstract
(pdf): Direct pdf download where available
Italic: ‘Takeaway’ snippet from abstract.
(Bracketed): My thoughts FWIW
Tags:

Transcranial direct current stimulation increases resting state interhemispheric connectivity.
the tDCS group showed increased DLPFC connectivity to the right hemisphere and decreased DLPFC connectivity to the brain regions around the stimulation site in the left hemisphere. (Lends more credence to the idea of increasing positive effects of tDCS by simultaneously damping down (cathodal) and ramping up (anodal) neuronal activity.)
Tags: theory, learning, enhancement

Transcranial direct current stimulation for treatment of refractory childhood focal epilepsy.
A single session of cathodal tDCS improves epileptic EEG abnormalities for 48 h and is well-tolerated in children.
Tags: epilepsy, children

Brain stimulation modulates the autonomic nervous system, rating of perceived exertion and performance during maximal exercise.
…indicating that the brain plays a crucial role in the exercise performance regulation.
Tags: sports medicine

Evolution of Premotor Cortical Excitability after Cathodal Inhibition of the Primary Motor Cortex: A Sham-Controlled Serial Navigated TMS Study (pdf)
Cathodal inhibition of M1 excitability leads to a compensatory increase of ipsilateral PMC (premotor cortical regions) excitability. (Cathodal tDCS used as a tool to facilitate an experiment)
Tags: theory,

Rethinking Clinical Trials of Transcranial Direct Current Stimulation: Participant and Assessor Blinding Is Inadequate at Intensities of 2mA (pdf) (See also: A big hole in the control? Transcranial direct current stimulation blinding on trial)
Our results suggest that blinding in studies using tDCS at intensities of 2 mA is inadequate. Positive results from such studies should be interpreted with caution.
Tags: theory, sham, blinding,

The effects of cross-hemispheric dorsolateral prefrontal cortex transcranial direct current stimulation (tDCS) on task switching
Task switching, defined as the ability to flexibly switch between tasks in the face of goal shifting, is a central mechanism in cognitive control. …Our findings confirm the notion that involvement of the PFC on task switching depends critically on laterality, implying the existence of different roles for the left hemisphere and the right hemisphere in task switching.
Tags: task switching, theory

The role of timing in the induction of neuromodulation in perceptual learning by transcranial electric stimulation
tRNS (transcranial random noise stimulation) facilitated task performance only when it was applied during task execution, whereas anodal tDCS induced a larger facilitation if it was applied before task execution. (This study showed tDCS to be more effective when applied prior to training! (i.e. ‘offline’)
Tags: tRNS, offliine, online, training, enhancement, perceptual learning

Modulation of verbal fluency networks by transcranial direct current stimulation (tDCS) in Parkinson’s disease
…left dorsolateral prefrontal cortex (DLPFC) tDCS increased performance on the phonemic fluency task
Tags: Parkinson’s, verbal fluency

Transcranial Electrical Currents to Probe EEG Brain Rhythms and Memory Consolidation during Sleep in Humans (2011) (pdf)
…results demonstrate the suitability of oscillating-tDCS as a tool to analyze functions of endogenous EEG rhythms and underlying endogenous electric fields as well as the interactions between EEG rhythms of different frequencies. (Way over my head at this point but trying to understand it, as Lisa Marshall is frequently mentioned in discussions around tDCS and memory. I’m also trying to build an understanding of EEG.)
Tags: memory consolidation, EEG, theory

(pdf) Random Noise Stimulation Improves Neuroplasticity in Perceptual Learning (2011)
Our results confirmed the efficacy of hf-tRNS over the visual cortex in improving behavioral performance and showed its superiority in comparison to other TES. (tRNS transcranial random noise stimulation, has been showing up more often in relation to studies focused on learning and cognition.)
Tags: tRNS, perceptual learning, neural plasticity,

Focal Modulation of the Primary Motor Cortex in Fibromyalgia Using 4×1-Ring High-Definition Transcranial Direct Current Stimulation (HD-tDCS): Immediate and Delayed Analgesic Effects of Cathodal and Anodal Stimulation
4×1-ring HD-tDCS, a novel noninvasive brain stimulation technique capable of more focal and targeted stimulation, provides significant reduction in overall perceived pain in fibromyalgia patients..
Tags: HD-tDCS, Fibromyalgia, pain health

Transcranial direct current stimulation’s effect on novice versus experienced learning (2011)
TDCS was significantly more effective in enhancing test performance when applied in novice learners than in experienced learners.
Tags: learning, threat detection, anode F8,

Evaluation of sham transcranial direct current stimulation for randomized, placebo-controlled clinical trials.
The tDCS sham condition investigated here may be suitable for placebo-controlled trials keeping subjects blind to treatment conditions. (The protocol for sham tDCS is necessarily evolving.)
Tags: sham,

Tremor Suppression by Rhythmic Transcranial Current Stimulation
With this technique we can achieve almost 50% average reduction in resting tremor amplitude and in so doing form the basis of a closed-loop tremor-suppression therapy that could be extended to other oscillopathies. (tACS transcranial alternating current)
Tags: Parkinsons, tremor, tACS

Is Transcranial Alternating Current Stimulation Effective in Modulating Brain Oscillations? (pdf)
Therefore, the present study does not provide significant evidence for tACS reliably inducing direct modulations of brain oscillations that can influence performance in a visual task.
Tags: tACS, posterior parietal cortex, visual perception

Neuromodulation for Brain Disorders: Challenges and Opportunities (pdf)
This article reviews the state-of-the-art of neuromodulation for brain disorders and discusses the challenges and opportunities available for clinicians and researchers interested in advancing neuromodulation therapies. (Excellent overview of where we’re at with various forms of brain stimulation)
Tags: Neuromodulation, brain stimulation, tDCS, DBS (Deep Brain Stimulation), ICS (intracranial cortical stimulation), TMS (transcranial magnetic stimulation)

Improved proper name recall in aging after electrical stimulation of the anterior temporal lobes (2011) (pdf)
The task was to look at pictures of famous faces or landmarks and verbally recall the associated proper name. Our results show a numerical improvement in face naming after left or right ATL stimulation, but a statistically significant effect only after left-lateralized stimulation.
Tags: name recall, anterior temporal lobes, aging,

Transcranial brain stimulation (not sure this link will work for you pdf)
This book reviews recent advances made in the field of brain stimulation techniques. Moreover NIBS techniques exert their effects on neuronal state through different mechanisms at cellular and functional level.
Tags: NIBS (non-invasive brains stimulation), research overview,

Naming facilitation induced by transcranial direct current stimulation. (2010)
…anodal tDCS of the left DLPFC improves naming performance, speeding up verbal reaction times after the end of the stimulation, whereas cathodal stimulation had no effect.
Tags: learning, left DLPFC,

Consolidation of Human Motor Cortical Neuroplasticity by D-Cycloserine (2004) (pdf)
While anodal tDCS enhances motor cortical excitability, cathodal tDCS diminishes it. Both effects seem to be NMDA receptor dependent. D-CYC selectively potentiated the duration of motor cortical excitability enhancements induced by anodal tDCS.(Again, way over my head, but NMDA receptors comes up frequently in the context of tDCS and neurotransmitters.)
Tags: NMDA receptors, D-Cycloserine, learning, enhancement

Interactions between transcranial direct current stimulation (tDCS) and pharmacological interventions in the Major Depressive Episode: Findings from a naturalistic study. (See also: Electrical Brain Stimulation Plus Drug Fights Depression)
…To investigate the interactions between tDCS and drug therapy …tDCS over the DLPFC acutely improved depressive symptoms.
Tags: depression, Zoloft

Physiological and modeling evidence for focal transcranial electrical brain stimulation in humans: A basis for high-definition tDCS.
We provide direct evidence in humans that TES with a 4 × 1-Ring configuration can activate motor cortex and that current does not substantially spread outside the stimulation area.
Tags: HD-tDCS, electrodes, M1

Transcranial Direct Current Stimulation (tDCS) Reduces Postsurgical Opioid Consumption in Total Knee Arthroplasty (TKA).
…tDCS may be able to reduce post-TKA opioid requirements.
Tags: pain,

Modulating lexical and semantic processing by transcranial direct current stimulation.…(tDCS), which is applied over Wernicke’s area and its right homologue, to influence lexical decisions and semantic priming…
Results showed impaired lexical processing under right anodal/left cathodal stimulation in comparison with sham and left anodal/right cathodal stimulation.