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A Novel tDCS Sham Approach Based on Model-Driven Controlled Shunting
Brain Stimulation ( IF 7.7 ) Pub Date : 2020-03-01 , DOI: 10.1016/j.brs.2019.11.004
Francesco Neri 1 , Lucia Mencarelli 1 , Arianna Menardi 1 , Fabio Giovannelli 2 , Simone Rossi 3 , Giulia Sprugnoli 4 , Alessandro Rossi 5 , Alvaro Pascual-Leone 6 , Ricardo Salvador 7 , Giulio Ruffini 7 , Emiliano Santarnecchi 8
Affiliation  

BACKGROUND Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique able to transiently modulate brain activity, is surging as one of the most promising therapeutic solutions in many neurological and psychiatric disorders. However, profound limitations exist in current placebo (sham) protocols that limit single- and double-blinding, especially in non-naïve subjects. OBJECTIVE To ensure better blinding and strengthen reliability of tDCS studies and trials, we tested a new optimization algorithm aimed at creating an "active" sham tDCS condition (ActiSham hereafter) capable of inducing the same scalp sensations perceived during real stimulation while preventing currents from reaching the cortex and cause changes in brain excitability. METHODS A novel model-based multielectrode technique - optimizing the location and currents of a set of small electrodes placed on the scalp - was used to control the relative amount of current delivered transcranially in real and placebo multichannel tDCS conditions. The presence, intensity and localization of scalp sensations during tDCS was evaluated by means of a specifically designed questionnaire administered to the participants. We compared blinding ratings by directly addressing subjects' ability to discriminate across conditions for both traditional (Bifocal-tDCS and Sham, using sponge electrodes) and our novel multifocal approach (both real Multifocal-tDCS and ActiSham). Changes in corticospinal excitability were monitored based on Motor Evoked Potentials (MEPs) recorded via concurrent Transcranial Magnetic Stimulation (TMS) and electromyography (EMG). RESULTS Participants perceived Multifocal-tDCS and ActiSham similarly in terms of both localization and intensity of scalp sensations, whereas traditional Bifocal stimulation was rated as more painful and annoying compared to its Sham counterpart. Additionally, differences in scalp localization were reported for active/sham Bifocal-tDCS, with Sham tDCS inducing more widespread itching and burning sensations. As for MEPs amplitude, a main effect of stimulation was found when comparing Bifocal-Sham and ActiSham (F(1,13) = 6.67, p = .023), with higher MEPs amplitudes after the application of Bifocal-Sham. CONCLUSIONS Compared to traditional Bifocal-tDCS, ActiSham offers better participants' blinding by inducing very similar scalp sensations to those of real Multifocal tDCS both in terms of intensity and localization, while not affecting corticospinal excitability.

中文翻译:

基于模型驱动控制分流的新型 tDCS 模拟方法

背景技术经颅直流电刺激 (tDCS) 是一种能够瞬时调节大脑活动的非侵入性脑刺激技术,正迅速成为许多神经和精神疾病中最有前途的治疗方法之一。然而,目前限制单盲和双盲的安慰剂(假)方案存在很大的局限性,尤其是在非幼稚受试者中。目的 为了确保更好的盲法和增强 tDCS 研究和试验的可靠性,我们测试了一种新的优化算法,旨在创建一种“活跃”的假 tDCS 条件(以下简称 ActiSham),能够在真实刺激期间产生相同的头皮感觉,同时防止电流到达皮质并引起大脑兴奋性的变化。方法 一种基于模型的新型多电极技术 - 优化放置在头皮上的一组小电极的位置和电流 - 用于控制在真实和安慰剂多通道 tDCS 条件下经颅输送的相对电流量。tDCS 期间头皮感觉的存在、强度和定位是通过对参与者进行专门设计的调查问卷进行评估的。我们通过直接解决受试者区分传统(双焦点 tDCS 和假手术,使用海绵电极)和我们的新型多焦点方法(真正的多焦点 tDCS 和 ActiSham)的条件的能力来比较致盲评级。基于通过并发经颅磁刺激 (TMS) 和肌电图 (EMG) 记录的运动诱发电位 (MEP) 监测皮质脊髓兴奋性的变化。结果 参与者在头皮感觉的定位和强度方面对 Multifocal-tDCS 和 ActiSham 的感知相似,而传统的 Bifocal 刺激与 Sham 对应物相比被评为更痛苦和烦人。此外,据报道,主动/假 Bifocal-tDCS 的头皮定位存在差异,而假 tDCS 会引起更广泛的瘙痒和灼烧感。至于 MEPs 振幅,在比较 Bifocal-Sham 和 ActiSham (F(1,13) = 6.67,p = .023) 时发现了刺激的主要影响,在应用 Bifocal-Sham 后具有更高的 MEPs 振幅。结论 与传统双焦 tDCS 相比,
更新日期:2020-03-01
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