Adam J. Woods

A technical guide to tDCS, and related non-invasive brain stimulation tools.

Transcranial electrical stimulation (tES), including transcranial direct and alternating current stimulation (tDCS, tACS) are non-invasive brain stimulation techniques increasingly used for modulation of central nervous system excitability in humans. Here we address methodological issues required for tES application. This review covers technical aspects of tES, as well as applications like exploration of brain physiology, modelling approaches, tES in cognitive neurosciences, and interventional approaches. It aims to help the reader to appropriately design and conduct studies involving these brain stimulation techniques, understand limitations and avoid shortcomings, which might hamper the scientific rigor and potential applications in the clinical domain.

Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016.

This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3-13 A/m(2)) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations.

Dosage Considerations for Transcranial Direct Current Stimulation in Children: A Computational Modeling Study

Transcranial direct current stimulation (tDCS) is being widely investigated in adults as a therapeutic modality for brain disorders involving abnormal cortical excitability or disordered network activity. Interest is also growing in studying tDCS in children. Limited empirical studies in children suggest that tDCS is well tolerated and may have a similar safety profile as in adults. However, in electrotherapy as in pharmacotherapy, dose selection in children requires special attention, and simple extrapolation from adult studies may be inadequate. Critical aspects of dose adjustment include 1) differences in neurophysiology and disease, and 2) variation in brain electric fields for a specified dose due to gross anatomical differences between children and adults. In this study, we used high-resolution MRI derived finite element modeling simulations of two healthy children, ages 8 years and 12 years, and three healthy adults with varying head size to compare differences in electric field intensity and distribution. Multiple conventional and high-definition tDCS montages were tested. Our results suggest that on average, children will be exposed to higher peak electrical fields for a given applied current intensity than adults, but there is likely to be overlap between adults with smaller head size and children. In addition, exposure is montage specific. Variations in peak electrical fields were seen between the two pediatric models, despite comparable head size, suggesting that the relationship between neuroanatomic factors and bioavailable current dose is not trivial. In conclusion, caution is advised in using higher tDCS doses in children until 1) further modeling studies in a larger group shed light on the range of exposure possible by applied dose and age and 2) further studies correlate bioavailable dose estimates from modeling studies with empirically tested physiologic effects, such as modulation of motor evoked potentials after stimulation.

Sham transcranial magnetic stimulation using electrical stimulation of the scalp

BACKGROUND: Most methods of sham, repetitive transcranial magnetic stimulation (rTMS) fail to replicate the look, sound, and feel of active stimulation in the absence of a significant magnetic field. OBJECTIVE/HYPOTHESIS: To develop and validate a new method of sham rTMS appropriate for a double-blind, placebo-controlled study with subject crossover. METHODS: The look and sound of active rTMS was replicated using a matched, air-cooled sham TMS coil. Scalp muscle stimulation associated with rTMS was replicated using large rubber electrodes placed over selected muscles. The intensity and pulse width of electrical stimulation necessary to match 1-Hz rTMS was developed in one sample of normal subjects. The sham technique was validated in back-to-back comparisons with active rTMS in new samples of normal subjects who were either naïve or experienced with rTMS. RESULTS: Subjects naïve to TMS could not tell which type of stimulation was active or sham or which was electrical or magnetic. Naïve subjects incorrectly picked sham stimulation as active, when forced to choose, because electrical stimulation felt more focused than magnetic stimulation. Subjects experienced with TMS could correctly identify sham and active stimulation. Experimenters could detect subtle differences between conditions. CONCLUSIONS: This method of sham rTMS closely mimics the look, sound, and feel of active stimulation at 1Hz without creating a significant magnetic field. It is valid for use with naïve subjects and in crossover studies. It can accommodate differences in scalp muscle recruitment at different sites of stimulation, and it could potentially be used with higher frequency stimulation.

Context Modulates the Contribution of Time and Space in Causal Inference

Humans use kinematic temporal and spatial information from the environment to infer the causal dynamics (e.g., force) of an event. We hypothesize that the basis for these inferences are malleable and modulated by contextual temporal and spatial information. Specifically, the present research investigates whether the extent of a person’s ongoing experience with direct causal events (e.g., temporally contiguous and spatially continuous) alters their use of time and space in judgments of causality. Participants made inferences of causality on animated launching events depicting a blue ball colliding with and then “launching” a red ball. We parametrically manipulated temporal contiguity and spatial continuity by varying the duration of contact between the balls and the angle of the second ball’s movement. We manipulated participants’ level of exposure to direct causal events (i.e., events with no delay or angle change) between experiments (Experiment 1: 2%, Experiment 2: 25%, Experiment 3: 75%). We found that participants adjust the temporal and spatial parameters they use to judge causality to accommodate the context in which they apprehended launching events. Participants became more conservative in their use of temporal and spatial parameters to judge causality as their exposure to direct causal events increased. People use time and space flexibly to infer causality based on their ongoing experiences. Such flexibility in making causal inferences may have adaptive significance.

Progressive locomotor recalibration during blind walking

Blind walking has become a common measure of perceived target location. This article addresses the possibility that blind walking might vary systematically within an experimental session as participants accrue exposure to nonvisual locomotion. Such variations could complicate the interpretation of blind walking as a measure of perceived location. We measured walked distance, velocity, and pace length in indoor and outdoor environments (1.5-16.0 m target distances). Walked distance increased over 37 trials by approximately 9.33% of the target distance; velocity (and to a lesser extent, pace length) also increased, primarily in the first few trials. In addition, participants exhibited more unintentional forward drift in a blindfolded marching-in-place task after exposure to nonvisual walking. The results suggest that participants not only gain confidence as blind-walking exposure increases, but also adapt to nonvisual walking in a way that biases responses toward progressively longer walked distances.

Cognitive frailty: Frontiers and challenges

An international consensus group comprised of investigators from the International Academy of Nutrition and Aging (IANA) and the International Association of Gerontology and Geriatrics (IAGG) recently convened in Toulouse, France to establish a definition for cognitive frailty in older adults. This effort was motivated by growing awareness that many people with physical frailty are also prone to cognitive problems. In “Cognitive Frailty: Rationale and Definition” [1], an initial working definition was developed, and a framework proposed for future studies of cognitive frailty.

Frontal Gamma-Aminobutyric Acid Concentrations Are Associated With Cognitive Performance in Older Adults

BACKGROUND Gamma-aminobutyric acid (GABA), the brains principal inhibitory neurotransmitter, has been associated with perceptual and attentional functioning. Recent application of magnetic resonance spectroscopy (MRS) provides in vivo evidence for decreasing GABA concentrations during adulthood. It is unclear, however, how age-related decrements in cerebral GABA concentrations contribute to cognitive decline, or whether previously reported declines in cerebral GABA concentrations persist during healthy aging. We hypothesized that participants with higher GABA concentrations in the frontal cortex would exhibit superior cognitive function and that previously reported age-related decreases in cortical GABA concentrations continue into old age. METHODS We measured GABA concentrations in frontal and posterior midline cerebral regions using a Mescher-Garwood point-resolved spectroscopy (MEGA-PRESS) 1H-MRS approach in 94 older adults without history or clinical evidence of mild cognitive impairment or dementia (mean age, 73 years). We administered the Montreal Cognitive Assessment to assess cognitive functioning. RESULTS Greater frontal GABA concentrations were associated with superior cognitive performance. This relation remained significant after controlling for age, years of education, and brain atrophy. GABA concentrations in both frontal and posterior regions decreased as a function of age. CONCLUSIONS These novel findings from a large, healthy, older population indicate that cognitive function is sensitive to cerebral GABA concentrations in the frontal cortex, and GABA concentration in frontal and posterior regions continue to decline in later age. These effects suggest that proton MRS may provide a clinically useful method for the assessment of normal and abnormal age-related cognitive changes and the associated physiological contributors.

Language, perception, and the schematic representation of spatial relations

Schemas are abstract nonverbal representations that parsimoniously depict spatial relations. Despite their ubiquitous use in maps and diagrams, little is known about their neural instantiation. We sought to determine the extent to which schematic representations are neurally distinguished from language on the one hand, and from rich perceptual representations on the other. In patients with either left hemisphere damage or right hemisphere damage, a battery of matching tasks depicting categorical spatial relations was used to probe for the comprehension of basic spatial concepts across distinct representational formats (words, pictures, and schemas). Left hemisphere patients underperformed right hemisphere patients across all tasks. However, focused residual analyses using voxel-based lesion-symptom mapping (VLSM) suggest that (1) left hemisphere deficits in the representation of categorical spatial relations are difficult to distinguish from deficits in naming these relations and (2) the right hemisphere plays a special role in extracting schematic representations from richly textured pictures.

Effects of Electrode Drift in Transcranial Direct Current Stimulation

BACKGROUND Conventional transcranial direct current stimulation (tDCS) methods involve application of weak electrical current through electrodes encased in saline-soaked sponges affixed to the head using elastic straps. In the absence of careful preparation, electrodes can drift from their original location over the course of a tDCS session. OBJECTIVE The current paper investigates the influence of electrode drift on distribution of electric fields generated by conventional tDCS. METHODS MRI-derived finite element models of electric fields produced by tDCS were used to investigate the influence of incremental drift in electrodes for two of the most common electrode montages used in the literature: M1/SO (motor to contralateral supraorbital) and F3/F4 (bilateral frontal). Based on these models, we extracted predicted current intensity from 20 representative structures in the brain. RESULTS Results from separate RM-ANOVAs for M1/SO and F3/F4 montages demonstrated that 5% incremental drift in electrode position significantly changed the distribution of current delivered by tDCS to the human brain (Fs > 8.6, Ps < 0.001). Pairwise comparisons demonstrated that as little as 5% drift was able to produce significant differences in current intensity in structures distributed across the brain (Ps < 0.03). CONCLUSIONS Drift in electrode position during a session of tDCS produces significant alteration in the intensity of stimulation delivered to the brain. Elimination of this source of variability will facilitate replication and interpretation of tDCS findings. Furthermore, measurement and statistically accounting for drift may prove important for better characterizing the effects of tDCS on the human brain and behavior.